Treatment of heart attacks at rural and urban hospitals
Rory Miller, Garry Nixon, Robin M Turner, Tim Stokes, Rawiri Keenan, Corina Grey, Yannan Jiang, Susan Wells, Wil Harrison, Andrew J Kerr.
Investigations and treatment after non-ST segment elevation acute coronary syndrome for patients presenting to rural or urban hospitals in Aotearoa New Zealand: ANZACS-QI 75. New Zealand Medical Journal (Friday 10 November 2023 edition)
2023-11-15Congratulations Rory and the team - the full article can be found here if you are a NZMJ subscriber. Or, for an overview of the study check out the University of Otago Media Release https://www.otago.ac.nz/news/news/treatment-of-heart-attacks-at-rural-and-urban-hospitals
There's also an interview with Rory c/o RNZ Midday Rural News here
Abstract
Aims: Compare the care patients with non-ST segment elevation acute coronary syndrome (NSTEACS) received in Aotearoa New Zealand depending on the rural–urban category of the hospital they are first admitted to.
Methods: Patients with NSTEACS investigated with invasive coronary angiogram between 1 January 2014 and 31 December 2019 were included. There were three hospital categories (routine access to percutaneous coronary intervention [urban interventional], other urban [urban non-interventional] and rural) and three ethnicity categories (Māori, Pacific and non-Māori/non-Pacific). Clinical performance measures included: angiography ≤3 days, assessment of left ventricular ejection fraction (LVEF) and prescription of secondary prevention medication.
Results: Of 26,779 patients, 66.2% presented to urban-interventional, 25.6% to urban non-interventional and 8.2% to rural hospitals. A smaller percentage of patients presenting to urban interventional than urban non-interventional and rural hospitals were Māori (8.1%, 17.0% and 13.0%). Patients presenting to urban interventional hospitals were more likely to receive timely angiography than urban non-interventional or rural hospitals (78.5%, 60.8% and 63.1%). They were also more likely to have a LVEF assessment (78.5%, 65.4% and 66.3%). In contrast, the use of secondary prevention medications at discharge was similar between hospital categories.
Māori and Pacific patients presenting to urban interventional hospitals were less likely than non-Māori/non-Pacific to receive timely angiography but more likely to have LVEF assessed. However, LVEF assessment and timely angiography in urban non-interventional and rural hospitals were lower than in urban interventional hospitals for both Māori and non-Māori/non-Pacific.
Conclusions: Patients presenting to urban hospitals without routine interventional access and rural hospitals were less likely to receive LVEF assessment or timely angiography. This disproportionately impacts Māori, who are more likely to live in these hospital catchments.