Abstract
BackgroundSpecialized cardiology services have contributed to reduced mortality in acute coronary syndromes (ACS). We sought to evaluate the outcomes of ACS patients admitted to non-cardiology services in Southern Alberta.MethodsRetrospective chart review performed on all troponin-positive patients in the Calgary Health Region identified those diagnosed with ACS by their attending team. Patients admitted to non-cardiology and cardiology services were compared, using linked data from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry and the Strategic Clinical Network for Cardiovascular Health and Stroke.ResultsFrom January 1, 2007 to December 31, 2008, 2105 ACS patients were identified, with 1636 (77.7%) admitted to cardiology and 469 (22.3%) to non-cardiology services. Patients admitted to non-cardiology services were older, had more comorbidities, and rarely received cardiology consultation (5.1%). Cardiac catheterization was underutilized (5.1% vs 86.4% in cardiology patients (p < 0.0001)), as was evidence-based pharmacotherapy (p < 0.0001). Following adjustment for baseline comorbidities, 30-day through 4-year mortality was significantly higher on non-cardiology vs. cardiology services (49.1% vs. 11.0% respectively at 4-years, p < 0.0001).ConclusionIn a large ACS population in the Calgary Health Region, 25% were admitted to non-cardiology services. These patients had worse outcomes, despite adjustment for baseline risk factor differences. Although many patients were appropriately admitted to non-cardiology services, the low use of investigations and secondary prevention medications may contribute to poorer patient outcome. Further research is required to identify process of care strategies to improve outcomes and lessen the burden of illness for patients and the health care system.
Highlights
Specialized cardiology services have contributed to reduced mortality in acute coronary syndromes (ACS)
[19] other studies have shown that the average patient admitted to a cardiology ward is much younger, with fewer comorbidities and an attenuated benefit with specialist treatment is seen when outcomes are adjusted for baseline risk factor differences [10, 20]
Our objective was to evaluate the investigation and treatment of ACS patients admitted to a cardiology service versus a non-cardiology service, to determine whether admitting service was associated with the patient outcome of mortality or re-hospitalization
Summary
Specialized cardiology services have contributed to reduced mortality in acute coronary syndromes (ACS). Coronary Care Units (CCU) have been shown to contribute to a reduction in mortality in acute coronary syndrome (ACS) since the 1960’s [1,2,3,4,5,6,7,8,9]. This is thought to be related to more intensive monitoring, timely recognition and treatment of life-threatening arrhythmias, and. Shreiber et al found ACS patients admitted to a cardiology service were more likely to be treated with evidence-based secondary prevention medications. Nash and colleagues demonstrated that ACS patients treated by a cardiologist had a 30% lower inhospital mortality compared to those treated by a general practitioner or internist. [19] other studies have shown that the average patient admitted to a cardiology ward is much younger, with fewer comorbidities and an attenuated benefit with specialist treatment is seen when outcomes are adjusted for baseline risk factor differences [10, 20]
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