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Association of admitting physician specialty and care quality and outcomes in non-ST-segment elevation myocardial infarction (NSTEMI): insights from a national registry.
- Source :
-
European heart journal. Quality of care & clinical outcomes [Eur Heart J Qual Care Clin Outcomes] 2022 Aug 17; Vol. 8 (5), pp. 557-567. - Publication Year :
- 2022
-
Abstract
- Aim: Little is known about the association between admitting physician specialty and care quality and outcomes for non-ST-segment elevation myocardial infarction (NSTEMI).<br />Methods and Results: We identified 288 420 patients hospitalized with NSTEMI between 2010 and 2017 in the UK Myocardial Infarction National Audit Project database. The cohort was dichotomized according to care under a non-cardiologist (n = 146 722) and care under a cardiologist (n = 141 698) within the first 24 h of admission to hospital. Patients admitted under a cardiologist were significantly younger (70 vs. 75 years, P < 0.001), and less likely to be female (32% vs. 39%, P < 0.001). Independent factors associated with admission under a cardiologist included prior history of percutaneous coronary intervention (PCI) [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01-1.07; P = 0.04], hypercholesterolaemia (OR 1.17, 95% CI 1.15-1.20; P < 0.001), hypertension (OR 1.03, 95% CI 1.01-1.04; P = 0.01), and admission to an interventional centre (OR 3.90, 95% CI 3.79-4.00; P < 0.001). Patients admitted under cardiology were more likely to receive optimal pharmacotherapy, undergo invasive coronary angiography (79% vs. 60%, P < 0.001), and receive revascularization in the form of PCI (52% vs. 36%, P < 0.001). Following propensity score matching, odds of in-hospital all-cause mortality (OR 0.81, 95% CI 0.79-0.85; P < 0.001), re-infarction (OR 0.78, 95% CI 0.66-0.91; P = 0.001), and major adverse cardiovascular events (OR 0.81, 95% CI 0.78-0.84; P < 0.001) were lower in patients admitted under a cardiologist.<br />Conclusion: Patients with NSTEMI admitted under a cardiologist within 24 h of hospital admission were more likely to receive guideline-directed management and had better clinical outcomes.<br /> (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.)
- Subjects :
- Female
Humans
Male
Registries
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Myocardial Infarction epidemiology
Myocardial Infarction surgery
Non-ST Elevated Myocardial Infarction epidemiology
Non-ST Elevated Myocardial Infarction surgery
Percutaneous Coronary Intervention adverse effects
Physicians
ST Elevation Myocardial Infarction epidemiology
ST Elevation Myocardial Infarction surgery
Subjects
Details
- Language :
- English
- ISSN :
- 2058-1742
- Volume :
- 8
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- European heart journal. Quality of care & clinical outcomes
- Publication Type :
- Academic Journal
- Accession number :
- 33982094
- Full Text :
- https://doi.org/10.1093/ehjqcco/qcab038