The management of acute coronary syndrome patients across New Zealand in 2012: results of a third comprehensive nationwide audit and observations of current interventional care

Abstract

Aims: To audit all patients admitted to a New Zealand (NZ) Hospital with a suspected or definite acute coronary syndrome (ACS) over a 14-day period, to assess their presentation type and management in hospital and at discharge, with emphasis on time delays for invasive management and revascularisation treatments.

Methods: We updated the established NZ ACS Audit group of 39 hospitals admitting ACS patients across NZ, and enrolled NZ patients in conjunction with the bi-National Australia and NZ ACS 'SNAPSHOT' audit. Comprehensive data was recorded on all patients admitted between 00.00 hours on 14 May 2012 to 24.00 hours on 27 May 2012. Patient management at intervention centres (7 public, 3 private) was compared with non-intervention centres (29 public).

Results: There were 1007 patient admissions: STEMI (10%), NSTEMI (26%), UAP (17%), other diagnoses including secondary myonecrosis (18%), chest pain thought unlikely to be ischaemic (29%). Cardiac investigations were used in a minority of patients: chest X-ray (91%), echocardiogram (29%), exercise test (23%), computed tomographic (CT) angiogram (4%) and conventional coronary angiogram (33%). Patients admitted to a non-intervention centre (n=439) were less likely to receive an echocardiogram (25 vs 31%, p<0.05). Non-intervention centre patients with NSTEMI/UAP waiting longer for angiography (3.8 vs 2.1 days p<0.0001), and had a longer length of hospital stay (4.0 vs 3.1 days, p=0.043). For patients with a final diagnosis of a definite ACS (n=531), non-intervention centre patients were significantly less likely to be revascularised with PCI (25% vs 37%, p=0.0019) although CABG surgery numbers were not statistically different (4.1% vs 7.3%, p=0.13).

Conclusions: A collaborative group of clinicians and nurses has performed a third nationwide audit of suspected and definite ACS patients, and shown some gaps in the current service, including limited access to echocardiography and cardiac angiography. In particular we noted significant delays for non-intervention centre patients accessing planned invasive assessment. This study reveals areas of clinical need and emphasises the benefit of ongoing clinical audit, with subsequent feedback and a focus on integrated clinical service delivery, which can improve the care of ACS patients in New Zealand.