Abstract
Patients with acute coronary syndrome (ACS) transferred to regional nonacademic hospitals after percutaneous coronary intervention (PCI) may receive fewer preventive interventions than patients who remain in university hospitals. We aimed at comparing hospitals with and without PCI facilities regarding guidelines-recommended secondary prevention interventions after an ACS. We studied patients with ACS admitted to a university hospital with PCI facilities in Switzerland, and either transferred within 48 hours to regional nonacademic hospitals without PCI facilities or directly discharged from the university hospital. We measured prescription rates of evidence-based recommended therapies after ACS including reasons for nonprescription of aspirin, statins, β-blockers, angiotensin converting-enzyme inhibitors (ACEI) / angiotensin II receptor blockers (ARB), along with cardiac rehabilitation attendance and delivery of a smoking cessation intervention. Overall, 720 patients with ACS were enrolled; 541 (75.1%) were discharged from the hospital with PCI facilities, 179 (24.9%) were transferred to hospitals without PCI facilities. Concomitant prescription of aspirin, β-blockers, ACEI/ARB and statins at discharge was similar in hospitals with and without PCI facilities, reaching 83.9% and 85.5%, respectively (p = 0.62). Attendance at cardiac rehabilitation reached 55.5% for the hospital with PCI facilities and 65.7% for hospitals without PCI facilities (p = 0.02). In-hospital smoking cessation interventions were delivered to 70.8% patients exclusively at the hospital with PCI facilities. Quality of care for patients with ACS discharged from hospitals without PCI facilities was similar to that of patients directly discharged from the hospital with PCI facilities, except for in-hospital smoking cessation counselling and cardiac rehabilitation attendance.
Highlights
Compared with university hospitals, smaller regional nonacademic hospitals might be prone to low quality of care, regarding appropriate treatment prescribed at discharge [1]
Participants discharged from the university hospital with percutaneous coronary intervention (PCI) facilities were more likely to have dyslipidaemia, hypertension, diabetes, and non-ST-segment elevation myocardial infarction (NSTEMI) than those discharged at regional nonacademic hospitals without PCI facilities
Taking into account reasons for nonprescription, the prescription rate of evidence-based therapies at discharge, including statins, aspirin, β-blockers, angiotensin converting-enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) was similar between the university hospital with PCI facilities and the regional nonacademic hospitals without PCI facilities (83.9 vs 85.5%, p = 0.6)
Summary
Smaller regional nonacademic hospitals might be prone to low quality of care, regarding appropriate treatment prescribed at discharge [1]. Clinical guidelines for best-practice management of acute coronary syndrome (ACS) recommend the prescription of antiplatelet drugs, statins, angiotensin converting enzyme inhibitors (ACEI) and β-blockers, as well as in-hospital smoking cessation interventions and the organisation of cardiac rehabilitation at discharge [2,3,4,5]. Using these guidelines as reference for quality of care, suboptimal management has often been reported with important geographic variation both in the USA and in Europe [6,7,8,9,10]. We aimed to assess the prescription rate of recommended preventive drugs and interventions after ACS, including reasons for nonprescription, comparing a large university hospital with PCI facilities with regional nonacademic hospitals without PCI facilities in Switzerland
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