ACS patients in New Zealand experience significant delays to access cardiac investigations and revascularisation treatment especially when admitted to non-interventional centres: results of the second comprehensive national audit of ACS patients.
OBJECTIVE
To compare the management of acute coronary syndrome (ACS) patients presenting to interventional versus non-interventional New Zealand hospitals, with emphasis, on access delays for invasive assessment and revascularisation treatments.


METHODS
Using data collected by the New Zealand Cardiac Society ACS Audit Group over 14 days from each hospital in New Zealand (n=39) that admits ACS patients, patient management at intervention centres (6 public, 3 private) was compared with non-intervention centres (30 public). Investigations and revascularisation procedures performed on transferred patients were attributed to the referring centre.


RESULTS
From 00.00 hours on 14 May 2007 to 24.00 hours on 27 May 2007, 1003 patients were admitted to a New Zealand hospital with a suspected or definite ACS: ST-segment-elevation myocardial infarction [STEMI] (8%), non-STEMI [NSTEMI] (41%), unstable angina pectoris [UAP] 33%, or another cardiac or medical diagnosis (17%). Patients admitted to a non-intervention centre (n=556) were older (median age 70 vs 66 years, p=0.0097), with similar risk factors, and were more likely to be of Maori (12% vs 5.8%, p<0.0001), and less likely to be of Indian (1.3% vs 4.5%, p=0.0026) or Pacific Island (2.0% vs 4.9%, p=0.012) ethnicity. Patients admitted to a non-intervention centre were less likely to have a chest X-ray performed (84% vs 93 %, p<0.0001), but, as likely to have an echocardiogram, exercise test, or cardiac angiogram for cardiac risk assessment as patients admitted to an intervention centre (n=447). However, only 1 in 2 patients overall underwent either treadmill testing or angiography, and only 1 in 3 underwent angiography. Time delays to access cardiac angiography were evident with only 23% of all patients receiving this test within 48 hours of hospital admission. Patients at non-intervention centres had a significantly longer median wait for cardiac angiography than those admitted to an intervention centre (5.1 vs 2.5 days, p<0.0001).


CONCLUSIONS
Patients admitted to a New Zealand hospital with an acute coronary syndrome experience delays in accessing investigations and subsequent revascularisation. Furthermore, inequity exists with delays being significantly longer for patients admitted to a non-intervention centre. A comprehensive national strategy is needed to improve access to optimal cardiac care.
Ellis
Chris
C
Cardiology Department, Green Lane CVS Services, Level 3, Auckland City Hospital, Grafton, Auckland 1023, New Zealand. chrise@adhb.govt.nz
Devlin
Gerard
G
Elliott
John
J
Matsis
Philip
P
Williams
Michael
M
Gamble
Greg
G
Hamer
Andrew
A
Richards
Mark
M
White
Harvey
H
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D017023:Coronary Angiography / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data*; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data*; D009520:New Zealand; D010343:Patient Admission / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data; D015996:Survival Rate; D055815:Young Adult