9th March 2018, Volume 131 Number 1471

Tom Kai Ming Wang, Kok-Lam Chow, Aaron Lin, Alexei Chataline, Harvey White, Matthew Dawes, Greg Gamble, Chris Ellis

Cardiovascular disease causes 33% of mortality in New Zealand and is the most common cause of death.1 Audits of the care of patients with acute coronary syndrome (ACS) are very…

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Summary

The study used comprehensive data from the previous 2012 National ACS (heart attack and unstable angina) audit to consider differences in patient management between those patients cared for by the cardiology and non-cardiology services. The current Ministry of Health-funded National database: the All New Zealand ACS Quality Improvement (ANZACS-QI) database, does not enrol non-cardiology ACS patients (at Auckland Hospital and potentially also at other large-centre hospitals), which will lead to inaccuracies with the data, and limitations to the quality improvement programme. There is a need to ensure complete capture of ACS patients on the National ANZACS-QI database, to allow appropriate assessment of available ACS services.

Abstract

Aim

To review the number, characteristics and clinical management of suspected ACS patients admitted to cardiology and non-cardiology services at Auckland City Hospital, to assess differences between these services and to assess the number who would potentially be enrolled in the All New Zealand Acute Coronary Syndrome (ACS) Quality Improvement Programme (ANZACS-QI) database.

Method

Auckland City Hospital patient data was extracted from the Australia and New Zealand ACS ‘SNAPSHOT’ audit, performed over 14 days in May 2012.

Results

There were 121 suspected ACS admissions to Auckland City hospital during the audit period, with 45 (37%) patients directly managed by the cardiology service, and 76 (63%) patients cared for by non-cardiology services. Based on the subsequent discharge diagnosis, the cardiology service had more patients with definite ACS than the non-cardiology services; 27/45 (60%) compared to 16/76 (21%), difference (95%CI) 39% (22–56), P<0.0001). Cardiology ACS patients were more likely to undergo echocardiography; 15/27 (56%) compared to 2/16 (13%), difference 42% (18–68), P=0.0089), coronary angiography; 21/27 (78%) compared to 3/16 (19%), difference (95%CI) 59% (34–84), P=0.0003), coronary revascularisation; 18/27 (67%) compared to 3/16 (19%), difference (95%CI) 48% (22–74), P=0.004, and be discharged on two antiplatelet agents; 18/26 (69%) compared to 3/15 (20%), difference (95%CI) 49% (22–76), P=0.0036, or an ACEI/ARB; 20/26 (77%) compared to 5/15 (33%), difference (95%CI) 44% (15–72), P=0.0088.

Conclusion

In patients with a discharge diagnosis of definite ACS, those managed by non-cardiology services were less likely to receive guideline-recommended investigations, and management, in this relatively small cohort study. About one-third of all ACS patients are managed by non-cardiology services and would not be recorded by the ANZACS-QI database.

Author Information

Tom Kai Ming Wang, Cardiology Department, Auckland City Hospital, Auckland;
Kok-Lam Chow, Cardiology Department, Auckland City Hospital, Auckland;
Aaron Lin, Cardiology Department, Auckland City Hospital, Auckland;
Alexei Chataline, Cardiology Department, Auckland City Hospital, Auckland;
Harvey White, Cardiology Department, Auckland City Hospital, Auckland;
Matthew Dawes, Department of General Medicine, Auckland City Hospital, Auckland; Department of Medicine, University of Auckland, Auckland; Greg Gamble, Department of Medicine, University of Auckland, Auckland; Chris Ellis, Cardiology Department, Auckland City Hospital, Auckland.

Correspondence

Dr Chris Ellis, Cardiologist, Cardiology Department, Greenlane CVS Services, Level 3, Auckland City Hospital, Grafton, Auckland 1023.

Correspondence Email

chrise@adhb.govt.nz

Competing Interests

Dr White reports grants from Sanofi Aventis, grants from Eli Lilly and Company, grants from National Institute of Health, grants, personal fees and non-financial support from AstraZeneca, grants and personal fees from Omthera Pharmaceuticals, grants and personal fees from Pfizer, grants and personal fees from Elsai Inc., grants from DalGen Products and Services, personal fees from Sirtex, personal fees from Acetelion, outside the submitted work.

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