Non-ST elevation myocardial infarction (NSTEMI) in three hospital settings in South Africa: does geography influence management and outcome? A retrospective cohort study.
BACKGROUND
Guidelines advise early angiography in non-ST elevation myocardial infarction (NSTEMI) to ensure an optimal outcome. Resource limitations in secondary hospitals in the Western Cape dictate a local guideline to treat NSTEMIs medically with out-patient assessment for angiography, unless mandatory indications for early angiography occur.


METHODS
A retrospective cohort study assessed NSTEMIs at Tygerberg Hospital (TBH), Karl Bremer Hospital (KBH) and Worcester Hospital (WH) over one year. Two cohorts were analysed, secondary hospitals (KBH and WH; SH) and secondary service within a tertiary hospital (TBH). Where differences were found, sub-analysis compared WH and KBH.


RESULTS
TBH and SH were similar at baseline and in clinical presentation. Cases at TBH were more likely to receive in-patient angiography (94 vs 51%, p < 0.0001), and had a lower in-patient mortality rate (6 vs 23%, p = 0.0326). There was no difference between KBH and WH in sub-analysis.


CONCLUSIONS
This study confirmed that the management and mortality of NSTEMIs in the public health sector in the Western Cape, South Africa is not influenced by geography, but rather by the level of service available in the hospital of first presentation.
Division of Cardiology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, South Africa.
Jane
J
Moses
Anton F
AF
Doubell
Philip G
PG
Herbst
Karl J C
KJ
Klusmann
Hellmuth S V H
HS
Weich
D000368:Aged; D017023:Coronary Angiography / Q000592:standards; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D054625:Healthcare Disparities; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D009204:Myocardial Revascularization; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D010343:Patient Admission; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012189:Retrospective Studies; D063728:Secondary Care Centers; D013019:South Africa; D062606:Tertiary Care Centers; D061665:Time-to-Treatment; D016896:Treatment Outcome