National variation in coronary angiography rates and timing after an acute coronary syndrome in New Zealand (ANZACS-QI 6)
Williams, M.J.A.; Harding, S.A.; Devlin, G.; Nunn, C.; El-Jack, S.; Scott, T.; Lee, M.; Kerr, A.J.; Aitken, A.; Devlin, G.; Evison, K.; Kerr, A.; Larsen, P.; Marshall, K.; Simmonds, M.; Williams, M.; Smyth, D.; Stewart, R.; White, H.; Rhodes, M.; Lee, M.; Jenkins, M.; Faatui, J.; Newcombe, R.; Scott, T.; El-Jack, S.; Armstrong, G.; Khan, A.; Gladding, P.; Patel, H.; Edwards, C.; Donald, J.; Webster, M.; Ormiston, J.; White, H.; Stewart, J.; Ruygrok, P.; Ellis, C.; Coverdale, A.; Stewart, R.; Fly
New Zealand Medical Journal 129(1428): 66-78
2016
ISSN/ISBN: 0028-8446 PMID: 26914194 Document Number: 688485
The New Zealand Cardiac Clinical Network and the Ministry of Health recommend a "3-day door-to-catheter target" for acute coronary syndromes (ACS) admissions, requiring that at least 70% of ACS patients referred for invasive coronary angiography (ICA) undergo this within 3 days of hospital admission. We assessed the variability in use of ICA, timing of ICA, and duration of hospital admission across New Zealand District Health Boards (DHBs). All patients admitted to all New Zealand public hospitals with suspected ACS undergoing ICA over 1 year ending November 2014 had demographic, risk factor, and diagnostic data collected prospectively using the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry. Complete datasets were available in 7,988 (98.4%) patients. DHBs were categorised as those able to perform percutaneous coronary intervention on-site (intervention-capable) or not. There was a near two-fold variation between DHBs in the age standardised rate (ASR) of ICA ranging from 16.8 per 10,000 to 34.1 per 10,000 population (New Zealand rate; 27.9 per 10,000). Patients in intervention-capable DHBs had a 30% higher ASR of ICA. The proportion of ACS patients meeting the 3-day target ranged from 56.7% to 92.9% (New Zealand; 76.4%). Those in intervention-capable DHBs were more likely to meet the target (78.7% vs 68.0%, p<0.0001) and spent 0.84 days (p<.0001) less in hospital. There is a considerable variation in the rate and timing of ICA in New Zealand. Patients with ACS admitted to DHBs without interventional-capability are disadvantaged. New initiatives to correct this discrepancy are needed.