TY - JOUR

T1 - Influence of distance from home to invasive centre on invasive treatment after acute coronary syndrome: a nationwide study of 24 910 patients

AU - Hvelplund, Anders

AU - Galatius, Søren

AU - Madsen, Mette

AU - Rasmussen, Jeppe Nørgaard

AU - Sørensen, Rikke

AU - Fosbøl, Emil Loldrup

AU - Madsen, Jan Kyst

AU - Rasmussen, Søren

AU - Jørgensen, Erik

AU - Thuesen, Leif

AU - Møller, Christian Holflod

AU - Abildstrøm, Steen Zabell

PY - 2011/1/1

Y1 - 2011/1/1

N2 - To investigate whether distance from a patient's home to the nearest invasive centre influenced the invasive treatment strategy in acute coronary syndrome (ACS). Methods This was an observational cohort study using nationwide registries involving 24¿910 patients admitted with ACS (median age 67, range 30–90 years). All persons were grouped in tertiles according to the distance from their residence to the invasive centre. Cox proportional hazard models were applied to estimate the differences in coronary angiography and revascularisation rate within 60 days of admission according to the distance to the centre. The end points were coronary angiography and subsequent revascularisation. Results Of 24¿910 patients with a first ACS, 33% resided <21 km from one of the five invasive centres in Denmark, 33% lived between 21 and 64 km away and 34% lived >64 km away. The incidence of coronary angiography was 68% for long distance versus 77% for short distance (p<0.05), with an HR of 0.78 (95% CI 0.75 to 0.81, p<0.0001). Adjustment for patient characteristics such as age, sex, co-morbidity and socioeconomic status did not attenuate the difference (HR 0.74, 95% CI 0.71 to 0.77, p<0.0001). Furthermore, revascularisation in the subgroup examined with coronary angiography was less likely for those residing a long distance from the invasive centre compared with those living nearer (adjusted HR of 0.82 (95% CI 0.78 to 0.85, p<0.0001). Conclusions In patients hospitalised with ACS, invasive examination and treatment were less likely the further away from an invasive centre the patients resided, thus equal and uniform invasive examination and treatment was not found.

AB - To investigate whether distance from a patient's home to the nearest invasive centre influenced the invasive treatment strategy in acute coronary syndrome (ACS). Methods This was an observational cohort study using nationwide registries involving 24¿910 patients admitted with ACS (median age 67, range 30–90 years). All persons were grouped in tertiles according to the distance from their residence to the invasive centre. Cox proportional hazard models were applied to estimate the differences in coronary angiography and revascularisation rate within 60 days of admission according to the distance to the centre. The end points were coronary angiography and subsequent revascularisation. Results Of 24¿910 patients with a first ACS, 33% resided <21 km from one of the five invasive centres in Denmark, 33% lived between 21 and 64 km away and 34% lived >64 km away. The incidence of coronary angiography was 68% for long distance versus 77% for short distance (p<0.05), with an HR of 0.78 (95% CI 0.75 to 0.81, p<0.0001). Adjustment for patient characteristics such as age, sex, co-morbidity and socioeconomic status did not attenuate the difference (HR 0.74, 95% CI 0.71 to 0.77, p<0.0001). Furthermore, revascularisation in the subgroup examined with coronary angiography was less likely for those residing a long distance from the invasive centre compared with those living nearer (adjusted HR of 0.82 (95% CI 0.78 to 0.85, p<0.0001). Conclusions In patients hospitalised with ACS, invasive examination and treatment were less likely the further away from an invasive centre the patients resided, thus equal and uniform invasive examination and treatment was not found.

KW - Acute Coronary Syndrome

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Angioplasty, Balloon, Coronary

KW - Coronary Angiography

KW - Coronary Artery Disease

KW - Coronary Care Units

KW - Denmark

KW - Female

KW - Health Services Accessibility

KW - Humans

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Myocardial Infarction

KW - Myocardial Revascularization

KW - Socioeconomic Factors

KW - Transportation of Patients

KW - Treatment Outcome

U2 - 10.1136/hrt.2010.203901

DO - 10.1136/hrt.2010.203901

M3 - Journal article

C2 - 21051459

VL - 97

SP - 27

EP - 32

JO - Heart

JF - Heart

SN - 1355-6037

IS - 1

ER -