title: National variation in coronary angiography rates and timing after an acute coronary syndrome in New Zealand (ANZACS-QI 6).
abstract: OBJECTIVE
  The New Zealand Cardiac Clinical Network and the Ministry of Health recommend a "3-day door-to-catheter target" for acute coronary syndromes (ACS) admissions, requiring that at least 70% of ACS patients referred for invasive coronary angiography (ICA) undergo this within 3 days of hospital admission. We assessed the variability in use of ICA, timing of ICA, and duration of hospital admission across New Zealand District Health Boards (DHBs).
  
  
  METHODS
  All patients admitted to all New Zealand public hospitals with suspected ACS undergoing ICA over 1 year ending November 2014 had demographic, risk factor, and diagnostic data collected prospectively using the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry. Complete datasets were available in 7,988 (98.4%) patients. DHBs were categorised as those able to perform percutaneous coronary intervention on-site (intervention-capable) or not.
  
  
  RESULTS
  There was a near two-fold variation between DHBs in the age standardised rate (ASR) of ICA ranging from 16.8 per 10,000 to 34.1 per 10,000 population (New Zealand rate; 27.9 per 10,000). Patients in intervention-capable DHBs had a 30% higher ASR of ICA. The proportion of ACS patients meeting the 3-day target ranged from 56.7% to 92.9% (New Zealand; 76.4%). Those in intervention-capable DHBs were more likely to meet the target (78.7% vs 68.0%, p<0.0001) and spent 0.84 days (p<.0001) less in hospital.
  
  
  CONCLUSIONS
  There is a considerable variation in the rate and timing of ICA in New Zealand. Patients with ACS admitted to DHBs without interventional-capability are disadvantaged. New initiatives to correct this discrepancy are needed.
authors.affiliation: Cardiology Department, Dunedin Hospital, 201 Great King Street, Private Bag 1921, Dunedin 9054, New Zealand. michael.williams@otago.ac.nz.
authors.forename: Michael J A
authors.initials: MJ
authors.lastname: Williams
authors.forename: Scott A
authors.initials: SA
authors.lastname: Harding
authors.forename: Gerard
authors.initials: G
authors.lastname: Devlin
authors.forename: Chris
authors.initials: C
authors.lastname: Nunn
authors.forename: Sief
authors.initials: S
authors.lastname: El-Jack
authors.forename: Tony
authors.initials: T
authors.lastname: Scott
authors.forename: Mildred
authors.initials: M
authors.lastname: Lee
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kerr
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000453:epidemiology; D054059:Coronary Occlusion / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010360:Patient Transfer / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D012042:Registries; D017678:Sex Distribution; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D055815:Young Adult