Impact of the admitting ward on 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 the type of admission ward and quality of care and outcomes for non-ST-segment elevation myocardial infarction (NSTEMI). METHODS & RESULTS: We analysed data from 337,155 NSTEMI admissions between 2010-2017 in the United Kingdom (UK) Myocardial Ischaemia National Audit Project (MINAP) database. The cohort was dichotomised according to receipt of care either on a medical (n = 142,876) or cardiac ward, inclusive of acute cardiac wards and cardiac care unit (n = 194,279) on admission to hospital. Patients admitted to a cardiac ward were younger (median age 70y vs 75y, P < 0.001), and less likely to be female (33% vs 40%, P < 0.001). Independent factors associated with admission to a cardiac ward included ischaemic ECG changes (OR: 1.20, 95% CI: 1.18-1.23) and prior percutaneous coronary intervention (PCI) (OR: 1.19, 95% CI: 1.16-1.22). Patients admitted to a cardiac ward were more likely to receive optimal pharmacotherapy with statin (85% vs 81%, P < 0.001) and dual antiplatelet therapy (DAPT) (91% vs 88%, P < 0.001) on discharge, undergo invasive coronary angiography (78% vs 59%, P < 0.001) and receive revascularisation in the form of PCI (52% vs 36%, P < 0.001). Following multivariable logistic regression, the odds of in-hospital all-cause mortality (OR: 0.75, 95% CI: 0.70-0.81) and major adverse cardiovascular events (MACE) (OR: 0.84, 95% CI: 0.78-0.91) were lower in patients admitted to a cardiac ward. CONCLUSION: Patients with NSTEMI admitted to a cardiac ward on admission were more likely to receive guideline directed management and had better clinical outcomes.