Spatial variation in the management and outcomes of acute coronary syndrome

Abstract

BackgroundRegional disparities in medical care and outcomes with patients suffering from an acute coronary syndrome (ACS) have been reported and raise the need to a better understanding of links between treatment, care and outcomes. Little is known about the relationship and its spatial variability between invasive cardiac procedure (ICP), hospital death (HD), length of stay (LoS) and early hospital readmission (EHR). The objectives were to describe and compare the regional rates of ICP, HD, EHR, and the average LoS after an ACS in 2000 in the province of Quebec. We also assessed whether there was a relationship between ICP and HD, LoS, and EHR, and if the relationships varied spatially.MethodsUsing secondary data from a provincial hospital register, a population-based retrospective cohort of 24,544 patients hospitalized in Quebec (Canada) for an ACS in 2000 was built. ACS was defined as myocardial infarction (ICD-9: 410) or unstable angina (ICD-9: 411). ICP was defined as the presence of angiography, angioplasty or aortocoronary bypass (CCA: 480–483, 489), HD as all death cause at index hospitalization, LoS as the number of days between admission and discharge from the index hospitalization, and EHR as hospital readmission for a coronary heart disease ≤30 days after discharge from hospital. The EHR was evaluated on survivors at discharge.ResultsICP rate was 43.7% varying from 29.4% to 51.6% according to regions. HD rate was 6.9% (range: 3.3–8.2%), average LoS was 11.5 days (range: 7.5–14.4; median LoS: 8 days) and EHR rate was 8.3% (range: 4.7–14.2%). ICP was positively associated with LoS and negatively with HD and EHR; the relationship between ICP and LoS varied spatially. An increased distance to a specialized cardiology center was associated with a decreased likelihood of ICP, a decrease in LoS, but an increased likelihood of EHR.ConclusionThe main results of this study are the regional variability of the outcomes even after accounting for age, gender, ICP and distance to a cardiology center; the significant relationships between ICP and HD, LoS and EHR, and the spatial variability in the relationships between ICP and LoS.

Regional Disparities in Mortality after Ischemic Heart Disease in a Brazilian State from 2006 to 2010

“…Other studies have shown that higher rates of IHD mortality are frequently associated with greater distances from a patient’s place of residence to a major reference interventional cardiology center which may increase the time delay to the specialized treatment initiation or even precluding it [2], [13], [47], [48], [49], [59]. However, one study analyzing the accessibility of cardiac interventional services in Alabama and Mississippi (USA) has demonstrated that the distance factor may not influence IHD mortality rate [52].…”

Spatial heterogeneity of climate and land‐cover constraints on distributions of tick‐borne pathogens

“…When conducting a GWR analysis, it is desirable to test the hypothesis that the more complex local model provides a statistically significant improvement in fit over the simpler global model. Although several methods have been developed to conduct these tests for the ordinary least squares variant of GWR, they are not applicable to logistic GWR (Vanasse et al ., 2005). Instead, we adopted the approach of Nakaya et al .…”

Influence of distance from home to invasive centre on invasive treatment after acute coronary syndrome: a nationwide study of 24 910 patients

“…In cardiac interventional procedures after ACS, distance and regional variation influence the patient's prognosis3 4; regional differences in the examination and treatment of patients with ACS have been reported 5 6. Contemporary reports on geographical differences in a modern invasive set-up for patients with ACS do not exist.…”