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Patient and hospital determinants of primary percutaneous coronary intervention in England, 2003-2013

M Hall1, K Laut1, T B Dondo1

  • 1Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.

Heart (British Cardiac Society)
|January 7, 2016
PubMed

Insights

Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) use increased significantly but varied by patient factors and hospitals. Older, sicker patients and certain hospitals had lower PPCI rates, indicating a need for equitable care.

Area of Science:

  • Cardiology
  • Public Health

Background:

  • Primary percutaneous coronary intervention (PPCI) is a crucial treatment for ST-elevation myocardial infarction (STEMI).
  • Implementation of PPCI varies significantly across countries and healthcare systems.

Purpose of the Study:

  • To investigate patient and hospital characteristics associated with PPCI utilization in England.
  • To identify factors influencing the variation in PPCI rates.

Main Methods:

  • Utilized national registry data (MINAP) from 84 NHS trusts in England (2003-2013).
  • Employed multilevel Poisson regression to model PPCI incidence rate ratios (IRR) based on patient and trust-level factors.

Main Results:

  • Standardized PPCI rates increased from 0.01% to 86.3% between 2003 and 2013.
  • PPCI rates were lower for patients with comorbidities (e.g., previous MI, heart failure, diabetes, renal failure), older age, and longer travel distances.
  • Higher PPCI rates were observed in trusts with more interventional cardiologists and a 24/7 PPCI service.
  • Significant unexplained variation in PPCI rates existed between trusts.

Conclusions:

  • Despite an 8-year implementation phase, PPCI utilization stabilized around 85%, with disparities for older and sicker patients.
  • Between-trust variation in PPCI rates persisted, not fully explained by staffing levels.
  • Adherence to clinical pathways for STEMI is essential to ensure equitable quality of care.
Abstract

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