Impact of the admitting ward on care quality and outcomes in non-ST-segment elevation myocardial infarction (NSTEMI): insights from a national registry

Saadiq M Moledina, Ahmad Shoaib, Louise Y. Sun, Phyo Kyaw Myint, Rafail A Kotronias, Benoy N. Shah, Chris P. Gale, Hude Quan, Rodrigo Bagur, Mamas A Mamas* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: 
Little is known about the association between the type of admission ward and quality of care and outcomes for non-ST-segment elevation myocardial infarction (NSTEMI).
Methods & Results: 
We analysed data from 337,155 NSTEMI admissions between 2010-2017 in the United Kingdom (UK) Myocardial Ischaemia National Audit Project (MINAP) database. The cohort was dichotomised according to receipt of care either on a medical (n=142,876) or cardiac ward, inclusive of acute cardiac wards and cardiac care unit (n=194,279) on admission to hospital. Patients admitted to a cardiac ward were younger (median age 70y vs 75y, P<0.001), and less likely to be female (33% vs 40%, P<0.001). Independent factors associated with admission to a cardiac ward included ischaemic ECG changes (OR: 1.20, 95% CI: 1.18-1.23) and prior percutaneous coronary intervention (PCI) (OR: 1.19, 95% CI: 1.16-1.22). Patients admitted to a cardiac ward were more likely to receiveoptimal pharmacotherapy with statin (85% vs 81%, P<0.001) and dual antiplatelet therapy (DAPT) (91% vs 88%, P<0.001) on discharge, undergo invasive coronary angiography (78% vs 59%, P<0.001) and receive revascularisation in the form of PCI (52% vs 36%, P<0.001).Following multivariable logistic regression, the odds of in-hospital all-cause mortality (OR:0.75, 95% CI: 0.70-0.81) and major adverse cardiovascular events (MACE) (OR: 0.84, 95% CI: 0.78-0.91) were lower in patients admitted to a cardiac ward.
Conclusion: 
Patients with NSTEMI admitted to a cardiac ward on admission were more likely to receive guideline directed management and had better clinical outcomes.
Original languageEnglish
Article numberqcab062
JournalEuropean Heart Journal - Quality of Care and Clinical Outcomes
Early online date4 Sep 2021
DOIs
Publication statusE-pub ahead of print - 4 Sep 2021

Keywords

  • NSTEMI
  • Ward
  • CCU
  • Mortality

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