title: Chain of care in chest pain--differences between three hospitals in an urban area.
abstract: OBJECTIVE
  To describe differences in treatment and delay times in acute chest pain at the three hospitals in Göteborg, Sweden.
  
  
  METHODS
  All patients admitted to the three hospitals within Sahlgrenska University (SU) (Sahlgrenska: SU/S, Östra: SU/Ö and Mölndal: SU/M) with acute chest pain during 3 months in 2008 were evaluated for diagnosis, early treatment and outcome.
  
  
  RESULTS
  In all, 2588 visits by 2393 patients were included (visits n=1253 SU/S; n=853 SU/Ö; n=482 SU/M) of which 50%, 63% and 51% were hospitalised (p<0.0001). Among hospitalised patients, a diagnosis of ACS was reported in 26%, 9% and 22% respectively (p<0.0001). Among ACS patients, 83%, 66% and 57% respectively underwent coronary angiography (p=0.004). The median delay to coronary angiography in ST-elevation myocardial infarction (STEMI) was 42 min at SU/S, 3h 47 min at SU/Ö and 2h 34 min at SU/M (p=0.008). The corresponding values for coronary angiography in unstable coronary artery disease were 42h 7min, 48h 35 min and 123h 42 min (p=0.007). Overall mortality at 30 days was 3.6%, 3.2% and 1.5% (NS) and, at 1 year, it was 9.9%, 9.6% and 7.3% respectively (NS).
  
  
  CONCLUSIONS
  In acute chest pain in the Municipality of Göteborg, there was a marked difference between hospitals in: 1) the percentage of hospitalised patients, 2) the percentage of ACS among hospitalised patients and 3) the delay to and rate of coronary angiography. The clinical consequences of these deviations remain to be proven.
authors: Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
authors: A
authors: A
authors: Ravn-Fischer
authors: T
authors: T
authors: Karlsson
authors: M
authors: M
authors: Santos
authors: B
authors: B
authors: Bergman
authors: P
authors: P
authors: Johanson
authors: J
authors: J
authors: Herlitz
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000628:therapy; D017023:Coronary Angiography / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014505:Urban Population / Q000639:trends