• Chris Ellis, Gerard Devlin, John Elliott, Philip Matsis, Michael Williams, Greg Gamble, Andrew Hamer, Mark Richards, Harvey White, and New Zealand Acute Coronary Syndromes (NZACS) Audit Group.
• Cardiology Department, Green Lane CVS Services, Level 3, Auckland City Hospital, Grafton, Auckland 1023, New Zealand. chrise@adhb.govt.nz
• N. Z. Med. J. 2010 Jul 30; 123 (1319): 44-60.

AimTo compare the management of acute coronary syndrome (ACS) patients presenting to interventional versus non-interventional New Zealand hospitals, with emphasis, on access delays for invasive assessment and revascularisation treatments.MethodsUsing data collected by the New Zealand Cardiac Society ACS Audit Group over 14 days from each hospital in New Zealand (n=39) that admits ACS patients, patient management at intervention centres (6 public, 3 private) was compared with non-intervention centres (30 public). Investigations and revascularisation procedures performed on transferred patients were attributed to the referring centre.ResultsFrom 00.00 hours on 14 May 2007 to 24.00 hours on 27 May 2007, 1003 patients were admitted to a New Zealand hospital with a suspected or definite ACS: ST-segment-elevation myocardial infarction [STEMI] (8%), non-STEMI [NSTEMI] (41%), unstable angina pectoris [UAP] 33%, or another cardiac or medical diagnosis (17%). Patients admitted to a non-intervention centre (n=556) were older (median age 70 vs 66 years, p=0.0097), with similar risk factors, and were more likely to be of Maori (12% vs 5.8%, p<0.0001), and less likely to be of Indian (1.3% vs 4.5%, p=0.0026) or Pacific Island (2.0% vs 4.9%, p=0.012) ethnicity. Patients admitted to a non-intervention centre were less likely to have a chest X-ray performed (84% vs 93 %, p<0.0001), but, as likely to have an echocardiogram, exercise test, or cardiac angiogram for cardiac risk assessment as patients admitted to an intervention centre (n=447). However, only 1 in 2 patients overall underwent either treadmill testing or angiography, and only 1 in 3 underwent angiography. Time delays to access cardiac angiography were evident with only 23% of all patients receiving this test within 48 hours of hospital admission. Patients at non-intervention centres had a significantly longer median wait for cardiac angiography than those admitted to an intervention centre (5.1 vs 2.5 days, p<0.0001).ConclusionsPatients admitted to a New Zealand hospital with an acute coronary syndrome experience delays in accessing investigations and subsequent revascularisation. Furthermore, inequity exists with delays being significantly longer for patients admitted to a non-intervention centre. A comprehensive national strategy is needed to improve access to optimal cardiac care.

34 keywords...

hide…