title: Nationwide trends in use and timeliness of diagnostic coronary angiography in acute coronary syndromes from 2005 to 2011: Does distance to invasive heart centres matter?
abstract: OBJECTIVE
  To examine trends in the use of diagnostic coronary angiography according to distance from home to the nearest invasive heart centre following implementation of fast-track protocols and extensive pre-hospital triaging of acute coronary syndrome patients.
  
  
  RESULTS
  We performed a register-based cohort study of all patients admitted to Danish hospitals with incident acute coronary syndrome in 2005-2011. Diagnostic coronary angiography within 60 days of admission was investigated according to distance tertiles (DTs) calculated as range from each patient's home to the nearest invasive heart centre (short DT: <22 km, medium DT: 22-65 km, long DT: >65 km). Cox proportional hazards models were applied.Among the 52,409 patients included, diagnostic coronary angiography was increasingly used during 2005-2011 (short DT: 76% to 81%; medium DT: 74% to 81%; long DT: 69% to 78%; all p-values for trend <0.001). Using the short DT as reference the adjusted hazard ratios for medium DT were 0.87 (0.84-0.89) for 2005-2007, 0.94 (0.90-0.98) for 2008-2009 and 0.94 (0.90-0.98) for 2010-2011. Corresponding figures for long DT were 0.74 (0.72-0.76) for 2005-2007, 0.87 (0.83-0.90) for 2008-2009 and 0.94 (0.90-0.98) for 2010-2011. Length of hospital stay, time to coronary angiography, and 60-day mortality decreased in all DT.
  
  
  CONCLUSIONS
  This nationwide study found significant increases in diagnostic coronary angiography use over time in incident acute coronary syndrome patients with a relatively larger increase in patients residing farthest from an invasive heart centre. Additionally, selected quality of care measures improved in the entire cohort, suggesting a benefit of national clinical protocols.
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark Kim.Wadt.Hansen@regionh.dk.
authors.forename: Kim W
authors.initials: KW
authors.lastname: Hansen
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Rikke
authors.initials: R
authors.lastname: Sørensen
authors.affiliation: Department of Public Health, University of Copenhagen, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Madsen
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Jan K
authors.initials: JK
authors.lastname: Madsen
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Jan S
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors.forename: Lene M
authors.initials: LM
authors.lastname: von Kappelgaard
authors.affiliation: Department of Thoracic Surgery, Odense University Hospital, Denmark.
authors.forename: Poul E
authors.initials: PE
authors.lastname: Mortensen
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Galatius
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging*; D000368:Aged; D015331:Cohort Studies; D017023:Coronary Angiography / Q000639:trends*; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D003718:Denmark; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D016016:Proportional Hazards Models; D012042:Registries; D013997:Time Factors; D014187:Transportation of Patients
keywords: Acute coronary syndromes; coronary angiography; population-based study; trends