Association of admitting physician specialty and care quality and outcomes in non-ST-segment elevation myocardial infarction (NSTEMI): insights from a national registry.

Abstract

BACKGROUND: Little is known about the association between admitting physician specialty and care quality and outcomes for non-ST-segment elevation myocardial infarction (NSTEMI). METHODS & RESULTS: We identified 288,420 patients hospitalised with NSTEMI between 2010-2017 in the United Kingdom (UK) Myocardial Infarction National Audit Project (MINAP) database. The cohort was dichotomised according to care under a non-cardiologist (n?=?146,722) and care under a cardiologist (n?=?141,698) within the first 24?hours of admission to hospital. Patients admitted under a cardiologist were significantly younger (70-years vs 75 years, P?<?0.001), and less likely to be female (32% vs 39%, P?<?0.001). Independent factors associated with admission under a cardiologist included: prior history of percutaneous coronary intervention (PCI) (OR:1.04, 95% CI:1.01-1.07, P?=?0.04), hypercholesterolaemia (OR: 1.17, 95% CI: 1.15-1.20, P?<?0.001), hypertension (OR: 1.03, 95% CI: 1.01-1.04, P?=?0.01) and admission to an interventional centre (OR: 3.90, 95% CI: 3.79 - 4.00, P?<?0.001). Patients admitted under cardiology were more likely to receive optimal pharmacotherapy, undergo invasive coronary angiography (79% vs 60%, P?<?0.001), and receive revascularization in the form of percutaneous coronary intervention (PCI) (52% vs 36%, P?<?0.001). Following propensity score matching, odds of in-hospital all-cause mortality (OR:0.81, 95% CI: 0.79-0.85, P?<?0.001), reinfarction (OR:0.78, 95% CI: 0.66-0.91, P?=?0.001) and major adverse cardiovascular events (MACE) (OR: 0.81, 95% CI: 0.78-0.84, P?<?0.001) were lower in patients admitted under a cardiologist. CONCLUSION: Patients with NSTEMI admitted under a cardiologist within 24?hours of hospital admission were more likely to receive guideline directed management and had better clinical outcomes.