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Impact of hospital proportion and volume on primary percutaneous coronary intervention performance in England and Wales.
- Source :
-
European heart journal [Eur Heart J] 2011 Mar; Vol. 32 (6), pp. 706-11. Date of Electronic Publication: 2010 Dec 31. - Publication Year :
- 2011
-
Abstract
- Aims: To quantify the determinants of primary percutaneous coronary intervention (PCI) performance in England and Wales between 2004 and 2007.<br />Methods and Results: All 8653 primary PCI cases admitted to acute hospitals in England and Wales as recorded in the Myocardial Ischaemia National Audit Project (MINAP) 2004-2007. We studied the impact of the volume of primary PCI cases (hospital volume) on door-to-balloon (DTB) times and the proportion of patients treated with primary PCI (hospital proportion) on 30-day mortality and employed regression analysis to identify reasons for DTB time variations with a multilevel component to express hospital variation. The proportion of patients receiving primary PCI increased from 5% in 2004 to 20% in 2007. Median DTB times reduced from 84 min in 2004 to 61 min in 2007. Median DTB times decreased as the number of primary PCI procedures increased. The 30-day all-cause mortality rate for hospitals performing primary PCI on >25% of ST-elevation myocardial infarction patients [5.0%; 95% confidence interval (CI): 3.9-6.1%] was almost double that of hospitals performing primary PCI on more than 75% (2.7%; 95% CI: 2.0-3.5%). Time-of-day, year of admission, sex, and diabetes significantly influenced DTB times. Hospital variation was evident by a hospital-level DTB time standard deviation of 12 min.<br />Conclusions: There was a large variation in DTB times between the best and worst performing hospitals. Although patient-related factors impacted upon DTB times, the volume and proportion of patients undergoing primary PCI were significantly associated with delay and early mortality-hospitals with the highest proportion of primary PCI had the lowest mortality.
- Subjects :
- Aged
Angioplasty, Balloon, Coronary standards
Emergency Medical Services standards
Emergency Medical Services statistics & numerical data
England epidemiology
Female
Hospital Mortality
Humans
Male
Medical Audit
Middle Aged
Myocardial Infarction mortality
Myocardial Revascularization statistics & numerical data
Thrombolytic Therapy statistics & numerical data
Time Factors
Wales epidemiology
Angioplasty, Balloon, Coronary statistics & numerical data
Health Facility Size statistics & numerical data
Myocardial Infarction therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1522-9645
- Volume :
- 32
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- European heart journal
- Publication Type :
- Academic Journal
- Accession number :
- 21196443
- Full Text :
- https://doi.org/10.1093/eurheartj/ehq476