ACS patients in New Zealand experience significant delays to access cardiac investigations and revascularisation treatment especially when admitted to non-interventional centres: results of the second comprehensive national audit of ACS patients

Abstract

Aim: To compare the management of acute coronary syndrome (ACS) patients presenting to interventional versus non-interventional New Zealand hospitals, with emphasis, on access delays for invasive assessment and revascularisation treatments.

Methods: Using data collected by the New Zealand Cardiac Society ACS Audit Group over 14 days from each hospital in New Zealand (n=39) that admits ACS patients, patient management at intervention centres (6 public, 3 private) was compared with non-intervention centres (30 public). Investigations and revascularisation procedures performed on transferred patients were attributed to the referring centre.

Results: From 00.00 hours on 14 May 2007 to 24.00 hours on 27 May 2007, 1003 patients were admitted to a New Zealand hospital with a suspected or definite ACS: ST-segment-elevation myocardial infarction [STEMI] (8%), non-STEMI [NSTEMI] (41%), unstable angina pectoris [UAP] 33%, or another cardiac or medical diagnosis (17%). Patients admitted to a non-intervention centre (n=556) were older (median age 70 vs 66 years, p=0.0097), with similar risk factors, and were more likely to be of Maori (12% vs 5.8%, p<0.0001), and less likely to be of Indian (1.3% vs 4.5%, p=0.0026) or Pacific Island (2.0% vs 4.9%, p=0.012) ethnicity. Patients admitted to a non-intervention centre were less likely to have a chest X-ray performed (84% vs 93 %, p<0.0001), but, as likely to have an echocardiogram, exercise test, or cardiac angiogram for cardiac risk assessment as patients admitted to an intervention centre (n=447). However, only 1 in 2 patients overall underwent either treadmill testing or angiography, and only 1 in 3 underwent angiography. Time delays to access cardiac angiography were evident with only 23% of all patients receiving this test within 48 hours of hospital admission. Patients at non-intervention centres had a significantly longer median wait for cardiac angiography than those admitted to an intervention centre (5.1 vs 2.5 days, p<0.0001).

Conclusions: Patients admitted to a New Zealand hospital with an acute coronary syndrome experience delays in accessing investigations and subsequent revascularisation. Furthermore, inequity exists with delays being significantly longer for patients admitted to a non-intervention centre. A comprehensive national strategy is needed to improve access to optimal cardiac care.