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Journal ArticleDOI

Hospital burden of suspected acute coronary syndromes: recent trends

01 May 2006-Heart (BMJ Group)-Vol. 92, Iss: 5, pp 691-692

TL;DR: The objective of this study was to describe the changing burden of suspected ACS on the hospital sector of the National Health Service in Scotland over the period 1990–2000.

AbstractNo study has described the burden to a health service of the complete spectrum of possible acute coronary syndromes (ACS). The objective of this study was to describe the changing burden of suspected ACS on the hospital sector of the National Health Service in Scotland over the period 1990–2000. The record linkage system for discharges from Scottish hospitals and deaths has been described previously.1 We identified all emergency hospitalisations of patients ⩾ 18 years old in Scotland between January 1990 and December 2000 where acute myocardial infarction (AMI; International classification of diseases , (ICD), ninth revision, code 410, ICD-10 I21, 22), angina (ICD-9 411, 413, ICD-10 I20, I249), or chest pain (ICD-9 786.5, ICD-10 R07) was coded as the principal diagnosis on discharge. Numbers and age and sex specific rates of discharges (and patients discharged), length of stay, revascularisation procedures, and deaths were studied. We used linear regression to examine trends in population hospitalisation rates, hospitalisation numbers, and …

Topics: Chest pain (52%), Population (52%)

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Citations
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Journal ArticleDOI
08 Jun 2010-BMJ
TL;DR: There was a small but significant reduction in the number of emergency admissions for myocardial infarction after the implementation of smoke-free legislation in England, and this builds on previous work by showing that such declines are observed even when underlying reductions in admissions and potential confounders are controlled for.
Abstract: Objective To measure the short term impact on hospital admissions for myocardial infarction of the introduction of smoke-free legislation in England on 1 July 2007. Design An interrupted time series design with routinely collected hospital episode statistics data. Analysis of admissions from July 2002 to September 2008 (providing five years’ data from before the legislation and 15 months’ data from after) using segmented Poisson regression. Setting England. Population All patients aged 18 or older living in England with an emergency admission coded with a primary diagnosis of myocardial infarction. Main outcome measures Weekly number of completed hospital admissions. Results After adjustment for secular and seasonal trends and variation in population size, there was a small but significant reduction in the number of emergency admissions for myocardial infarction after the implementation of smoke-free legislation (−2.4%, 95% confidence interval −4.06% to −0.66%, P=0.007). This equates to 1200 fewer emergency admissions for myocardial infarction (1600 including readmissions) in the first year after legislation. The reduction in admissions was significant in men (3.1%, P=0.001) and women (3.8%, P=0.007) aged 60 and over, and men (3.5%, P Conclusion This study adds to a growing body of evidence that smoke-free legislation leads to reductions in myocardial infarctions. It builds on previous work by showing that such declines are observed even when underlying reductions in admissions and potential confounders are controlled for. The considerably smaller decline in admissions observed in England compared with many other jurisdictions probably reflects aspects of the study design and the relatively low levels of exposure to secondhand smoke in England before the legislation.

162 citations


Journal ArticleDOI
TL;DR: Substantial changes have occurred over time in patient characteristics, diagnoses, and procedures within the coronary care unit of a large, academic medical center, in particular, there have been significant increases in noncardiovascular critical illness.
Abstract: Objective:To describe long-term temporal trends in patient characteristics, processes of care, and in-hospital outcomes among unselected admissions within the contemporary coronary care unit.Design:Hospital administrative database that records both payment and operation data.Setting:Coronary care un

131 citations


Journal ArticleDOI
01 Sep 2012-Heart
TL;DR: A steady decrease in hospitalisation rates with AMI, and a shift away from STEMI towards rising rates of NSTEMI patients who are increasingly older are found.
Abstract: Objective To study the temporal and gender trends in age-standardised hospitalisation rates, in-hospital mortality rates and indicators of health service use for acute myocardial infarction (AMI), and the sub-categories, ST elevation MI (STEMI) and non-ST elevation MI (NSTEMI), in Ireland, 1997–2008. Design, setting, patients Anonymised data from the hospital inpatient enquiry were studied for the ICD codes covering STEMI and NSTEMI in all 39 acute hospitals in Ireland over a 12-year period. Age standardisation (direct method) was used to study hospitalisation and in-hospital mortality rates. Joinpoint regression analysis was undertaken to identify significant inflection points in hospitalisation trends. Main outcome measures Age-standardised hospitalisation rates, in-hospital mortality and indicators of health service use (length of stay, bed days) for AMI, STEMI and NSTEMI patients. Results From 1997 to 2008, hospitalisation rates for AMI decreased by 27%, and by 68% for STEMI patients (test for trend p Conclusions The authors found a steady decrease in hospitalisation rates with AMI, and a shift away from STEMI towards rising rates of NSTEMI patients who are increasingly older. In an ageing population, and with increasing survival rates, surveillance of acute coronary syndrome and allied conditions is necessary to inform clinicians and policy makers.

51 citations


Journal ArticleDOI
01 Jul 2010-Heart
TL;DR: The prognosis of patients admitted with chest pain in which acute myocardial infarction has been ruled out has improved for the past 20 years, such that the 1-year mortality of these patients is now similar to that in the general population.
Abstract: Objective To study trends for 20 years in incidence and 1-year mortality in hospitalised patients who received a diagnosis of either angina or unexplained chest pain (UCP) in Sweden. Design and setting Register study of all patients aged 25–84 years identified from the Swedish National Hospital Discharge Register who were hospitalised with a first-time diagnosis of UCP or angina pectoris during 1987 to 2006. Participants A total of 378 454 patients, 235 855 with UCP and 142 599 with angina. Main outcome measures 1-Year mortality and standardised mortality ratios (SMRs). Results From the period 1987–1991 to 2002–2006, the observed 1-year mortality rate in men and women with UCP aged 25–74 years decreased from 2.19% to 1.45% and from 1.85% to 0.91%, respectively. SMRs decreased from 1.67 (95% CI 1.39 to 1.95) and 1.63 (1.27 to 2.00) to 1.09 (0.96 to 1.23) and 0.88 (0.75 to 1.00). Corresponding decreases in 1-year mortality for a discharge diagnosis of angina were from 6.50% to 2.49% in men and from 4.80% to 1.68% in women, with SMRs decreasing from 2.69 (2.33–3.05) and 2.59 (2.06–3.12) to 1.09 (0.93–1.25) and 1.05 (0.81–1.29), respectively. Similar changes occurred in patients aged 75–84 years. Only men with UCP aged 75–84 years still retained a slightly increased mortality (SMR 1.14 (1.01–1.28)). Conclusions The prognosis of patients admitted with chest pain in which acute myocardial infarction has been ruled out has improved for the past 20 years, such that the 1-year mortality of these patients is now similar to that in the general population.

27 citations


Journal ArticleDOI
TL;DR: See related research paper by Tu and colleagues, page [E118][1] for more details.
Abstract: See related research paper by Tu and colleagues, page [E118][1] Cardiovascular disease generates a substantial burden of illness in Canada and beyond. Yet recent epidemiologic trends have been very encouraging. Deaths and rates of morbidity from cardiovascular disease fell by at least 50% in most

20 citations


References
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Journal ArticleDOI
TL;DR: A CPU located in the emergency department can be a safe, effective, and cost-saving means of ensuring that patients with unstable angina who are considered to be at intermediate risk for cardiovascular events receive appropriate care.
Abstract: Background Nearly half of patients hospitalized with unstable angina eventually receive a non–cardiac-related diagnosis, yet 5 percent of patients with myocardial infarction are inappropriately discharged from the emergency department. We evaluated the safety, efficacy, and cost of admission to a chest-pain observation unit (CPU) located in the emergency department for such patients. Methods We performed a community-based, prospective, randomized trial of the safety, efficacy, and cost of admission to a CPU as compared with those of regular hospital admission for patients with unstable angina who were considered to be at intermediate risk for cardiovascular events in the short term. A total of 424 eligible patients were randomly assigned to routine hospital admission (a monitored bed under the care of the cardiology service) or admission to the CPU (where patients were cared for according to a strict protocol including aspirin, heparin, continuous ST-segment monitoring, determination of creatine kinase is...

521 citations


Journal Article
TL;DR: Howard Newcombe, pioneer and founder of probability matching techniques, has illustrated the continuing dialectic between the theory and the practical craft of linkage by being guided by the characteristics and structure of the data sets in question and close empirical attention to the emergent qualities of each linkage.
Abstract: Howard Newcombe, pioneer and founder of probability matching techniques, has illustrated the continuing dialectic between the theory and the practical craft of linkage. From the point of view of the development of record linkage in Scotland his most valuable contribution, beyond his initial formulation of the principles of probability matching, has been his emphasis on being guided by the characteristics and structure of the data sets in question and close empirical attention to the emergent qualities of each linkage (Newcombe et al. 1959; Newcombe, 1988). Particularly inspiring has been his insistence that probability matching is at heart a simple and intuitive process and should not be turned into a highly specialised procedure isolated from the day to day concerns of the organisation in which it is carried out (Newcombe et al. 1986).

378 citations


Journal ArticleDOI
31 Jan 2004-BMJ
TL;DR: Care in a chest pain observation unit seems to be more effective and more cost effective than routine care for patients with acute, undifferentiated chest pain.
Abstract: Objectives To measure the effectiveness and cost effectiveness of providing care in a chest pain observation unit compared with routine care for patients with acute, undifferentiated chest pain. Design Cluster randomised controlled trial, with 442 days randomised to the chest pain observation unit or routine care, and cost effectiveness analysis from a health service costing

249 citations


Journal ArticleDOI
08 Apr 2000-BMJ
TL;DR: Any scheme which safely avoided these unnecessary admissions might save resources, reduce stress for patients, and, crucially, reduce the worrying false negatives—those missed cases of high risk coronary heart disease.
Abstract: Emergency medical admissions are important. They continue to rise year after year; consume substantial NHS resources; disrupt other NHS activities; and generate winter bed crises.1 2 Patients with acute central chest pain account for 20-30% of emergency medical admissions.3 4 Most are admitted because of concern about unstable coronary heart disease. Yet fewer than half will have a final diagnosis of acute myocardial infarction or unstable angina.4 Patients without high risk coronary heart disease thus account for over half those presenting with chest pain and over 10% of all emergency medical admissions. Such patients could be safely managed without admission, and most would prefer it. The current system is therefore both ineffective and inefficient. Any scheme which safely avoided these unnecessary admissions might save resources, reduce stress for patients, and, crucially, reduce the worrying false negatives—those missed cases of high risk coronary heart disease. …

69 citations


Journal ArticleDOI
TL;DR: The Chest Pain Clinic service has a higher diagnostic yield for ischaemic heart disease than open access exercise electrocardiography, provides the General Practitioner with a firm clinical diagnosis in over 90% of cases, and identifies those patients requiring further treatment and invasive investigation.
Abstract: The aims of the Chest Pain Clinic were: to establish rapid-access, 'same-day', referral and attendance without a waiting list; to provide a diagnosis, treatment and follow-up plan for each patient; and to optimize the use of hospitalization for appropriate patients. Prospective data were collected from 1001 consecutive General Practitioner referrals to the Chest Pain Clinic over a 22-month period. Hospital admissions were reduced from an estimated 268 to 145 patients. Without a Chest Pain Clinic service, 213 (21%) would have been admitted inappropriately, and 89 (9%) with unstable angina or myocardial infarction would potentially have been managed in the community. A firm diagnosis was provided in 92% of cases (919 patients) with 42% (418) diagnosed as having ischaemic heart disease. The provision of a Chest Pain Clinic reduces the hospitalization of patients with benign non-cardiac chest pain whilst facilitating the identification of those patients with acute coronary syndromes requiring in-patient care. The Chest Pain Clinic service has a higher diagnostic yield for ischaemic heart disease than open access exercise electrocardiography, provides the General Practitioner with a firm clinical diagnosis in over 90% of cases, and identifies those patients requiring further treatment and invasive investigation.

51 citations