title: Are district general hospital patients with unstable angina at a disadvantage?
abstract: OBJECTIVE
  To determine whether patients with non-ST elevation acute coronary syndromes requiring coronary angiography and revascularisation have inferior access to these services if admitted to district general hospitals (DGHs) compared with similar patients admitted to a base hospital containing a tertiary cardiac centre.
  
  
  METHODS
  Prospective, consecutive monitoring of all patients with acute coronary syndromes accepted by the tertiary cardiac centre for angiography and revascularisation over a three month period (1 April to 30 June 2002).
  
  
  METHODS
  All patients accepted for angiography from DGHs and from within the base hospital with a diagnosis of acute coronary syndromes.
  
  
  METHODS
  Tertiary cardiac facility (Manchester Heart Centre at Manchester Royal Infirmary (MRI)).
  
  
  METHODS
  Time waited from referral to angiography and revascularisation.
  
  
  RESULTS
  A total of 184 patients with a diagnosis of non-ST elevation acute coronary syndromes underwent angiography with a view to revascularisation. Of these, 89 (48%) were admitted initially to MRI and 95 (52%) were admitted to a feeder DGH. DGH patients waited significantly longer from admission to angiography than MRI patients (median 13 days (25th-75th percentiles 7-19) v 5 days (3-8) respectively; p<0.0005). DGH patients therefore also waited longer from admission to revascularisation (15 days (6-20) v 6 days (3-9) respectively). Once transferred into the Manchester Heart Centre, DGH patients underwent angiography within a median of 1 day (1-2). More DGH patients than those from MRI underwent both coronary artery bypass grafting (21 (22%) v 8 (9%) respectively; p=0.015) and percutaneous coronary intervention (44 (46%) v 32 (36%) respectively; p=NS).
  
  
  CONCLUSIONS
  Patients admitted to feeder DGHs with non-ST elevation acute coronary syndromes wait significantly longer for access to invasive coronary assessment and revascularisation than similar patients admitted in the hospital that incorporates the tertiary cardiac centre. This inequity of access is determined by postcode rather than clinical priority.
authors.affiliation: University of Manchester Medical School, UK.
authors.forename: C
authors.initials: C
authors.lastname: Miller
authors.forename: K
authors.initials: K
authors.lastname: Lipscomb
authors.forename: N
authors.initials: N
authors.lastname: Curzen
mesh_terms: D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000628:therapy*; D016507:Cardiology Service, Hospital / Q000458:organization & administration; D017023:Coronary Angiography; D004739:England; D005260:Female; D006297:Health Services Accessibility; D006767:Hospitals, District / Q000592:standards*; D006769:Hospitals, General / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011446:Prospective Studies; D012041:Regional Medical Programs; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D019039:Platelet Glycoprotein GPIIb-IIIa Complex