TY - JOUR
T1 - Influence of distance from home to invasive centre on invasive treatment after acute coronary syndrome: a nationwide study of 24 910 patients
AU - Hvelplund, Anders
AU - Galatius, Søren
AU - Madsen, Mette
AU - Rasmussen, Jeppe Nørgaard
AU - Sørensen, Rikke
AU - Fosbøl, Emil Loldrup
AU - Madsen, Jan Kyst
AU - Rasmussen, Søren
AU - Jørgensen, Erik
AU - Thuesen, Leif
AU - Møller, Christian Holflod
AU - Abildstrøm, Steen Zabell
PY - 2011/1/1
Y1 - 2011/1/1
N2 - Objective: To investigate whether distance from a patient's home to the nearest invasive centre influenced the invasive treatment strategy in acute coronary syndrome (ACS). Methods: This was an observational cohort study using nationwide registries involving 24 910 patients admitted with ACS (median age 67, range 30-90 years). All persons were grouped in tertiles according to the distance from their residence to the invasive centre. Cox proportional hazard models were applied to estimate the differences in coronary angiography and revascularisation rate within 60 days of admission according to the distance to the centre. The end points were coronary angiography and subsequent revascularisation. Results: Of 24 910 patients with a first ACS, 33% resided <21 km from one of the five invasive centres in Denmark, 33% lived between 21 and 64 km away and 34% lived >64 km away. The incidence of coronary angiography was 68% for long distance versus 77% for short distance (p<0.05), with an HR of 0.78 (95% CI 0.75 to 0.81, p<0.0001). Adjustment for patient characteristics such as age, sex, co-morbidity and socioeconomic status did not attenuate the difference (HR 0.74, 95% CI 0.71 to 0.77, p<0.0001). Furthermore, revascularisation in the subgroup examined with coronary angiography was less likely for those residing a long distance from the invasive centre compared with those living nearer (adjusted HR of 0.82 (95% CI 0.78 to 0.85, p<0.0001). Conclusions: In patients hospitalised with ACS, invasive examination and treatment were less likely the further away from an invasive centre the patients resided, thus equal and uniform invasive examination and treatment was not found.
AB - Objective: To investigate whether distance from a patient's home to the nearest invasive centre influenced the invasive treatment strategy in acute coronary syndrome (ACS). Methods: This was an observational cohort study using nationwide registries involving 24 910 patients admitted with ACS (median age 67, range 30-90 years). All persons were grouped in tertiles according to the distance from their residence to the invasive centre. Cox proportional hazard models were applied to estimate the differences in coronary angiography and revascularisation rate within 60 days of admission according to the distance to the centre. The end points were coronary angiography and subsequent revascularisation. Results: Of 24 910 patients with a first ACS, 33% resided <21 km from one of the five invasive centres in Denmark, 33% lived between 21 and 64 km away and 34% lived >64 km away. The incidence of coronary angiography was 68% for long distance versus 77% for short distance (p<0.05), with an HR of 0.78 (95% CI 0.75 to 0.81, p<0.0001). Adjustment for patient characteristics such as age, sex, co-morbidity and socioeconomic status did not attenuate the difference (HR 0.74, 95% CI 0.71 to 0.77, p<0.0001). Furthermore, revascularisation in the subgroup examined with coronary angiography was less likely for those residing a long distance from the invasive centre compared with those living nearer (adjusted HR of 0.82 (95% CI 0.78 to 0.85, p<0.0001). Conclusions: In patients hospitalised with ACS, invasive examination and treatment were less likely the further away from an invasive centre the patients resided, thus equal and uniform invasive examination and treatment was not found.
KW - Acute Coronary Syndrome
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Angioplasty, Balloon, Coronary
KW - Coronary Angiography
KW - Coronary Artery Disease
KW - Coronary Care Units
KW - Denmark
KW - Female
KW - Health Services Accessibility
KW - Humans
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Myocardial Infarction
KW - Myocardial Revascularization
KW - Socioeconomic Factors
KW - Transportation of Patients
KW - Treatment Outcome
U2 - 10.1136/hrt.2010.203901
DO - 10.1136/hrt.2010.203901
M3 - Journal article
C2 - 21051459
SN - 1355-6037
VL - 97
SP - 27
EP - 32
JO - Heart
JF - Heart
IS - 1
ER -