Evidence map›Paper›PMID 25270854›Full record

Observational studyBMJ open2014

Does a 'direct' transfer protocol reduce time to coronary angiography for patients with non-ST-elevation acute coronary syndromes? A prospective observational study.

S M Gallagher, M J Lovell, D A Jones, E Ferguson, A Ahktar, Z Buckhoree, A Wragg, C J Knight, A Mathur, E J Smith and 4 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ open, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Observational
  3. Observational
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

S M GallagherDepartment of Cardiology, Barts Health NHS Trust, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK Department of Translational Medicine and Therapeutics, William Harvey Research, Queen Mary College, London, UK.
M J LovellDepartment of Cardiology, Barts Health NHS Trust, London, UK.
D A JonesDepartment of Cardiology, Barts Health NHS Trust, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary College, London, UK.
E FergusonDepartment of Cardiology, Barts Health NHS Trust, London, UK.
A AhktarDepartment of Cardiology, Barts Health NHS Trust, London, UK.
Z BuckhoreeDepartment of Cardiology, Barts Health NHS Trust, London, UK.
A WraggDepartment of Cardiology, Barts Health NHS Trust, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK.
C J KnightDepartment of Cardiology, Barts Health NHS Trust, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK.
A MathurDepartment of Cardiology, Barts Health NHS Trust, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary College, London, UK.
E J SmithDepartment of Cardiology, Barts Health NHS Trust, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK.
S CliffeDepartment of Cardiology, Barts Health NHS Trust, London, UK.
R A ArchboldDepartment of Cardiology, Barts Health NHS Trust, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK.
M T RothmanDepartment of Cardiology, Barts Health NHS Trust, London, UK.
A K JainDepartment of Cardiology, Barts Health NHS Trust, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, London, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveNational guidelines recommend 'early' coronary angiography within 96 h of presentation for patients with non-ST elevation acute coronary syndromes (NSTE-ACS). Most patients with NSTE-ACS present to their district general hospital (DGH), and await transfer to the regional cardiac centre for angiography. This care model has inherent time delays, and delivery of timely angiography is problematic. The objective of this study was to assess a novel clinical care pathway for the management of NSTE-ACS, known locally as the Heart Attack Centre-Extension or HAC-X, designed to rapidly identify patients with NSTE-ACS while in DGH emergency departments (ED) and facilitate transfer to the regional interventional centre for 'early' coronary angiography.

methodsThis was an observational study of 702 patients divided into two groups; 391 patients treated before the instigation of the HAC-X pathway (Pre-HAC-X), and 311 patients treated via the novel pathway (Post-HAC-X). Our primary study end point was time from ED admission to coronary angiography. We also assessed the length of hospital stay.

resultsMedian time from ED admission to coronary angiography was 7.2 (IQR 5.1-10.2) days pre-HAC-X compared to 1.0 (IQR 0.7-2.0) day post-HAC-X (p<0.001). Median length of hospital stay was 3.0 (IQR 2.0-6.0) days post-HAC-X v 9.0 (IQR 6.0-14.0) days pre-HAC-X (p<0.0005). This equates to a reduction of six hospital bed days per NSTE-ACS admission.

conclusionsThe introduction of this novel care pathway was associated with significant reductions in time to angiography and in total hospital bed occupancy for patients with NSTE-ACS.

Indexed as

Acute Coronary SyndromeAgedCardiac Care FacilitiesClinical ProtocolsCoronary AngiographyEmergency Service, HospitalFemaleHumansLength of StayMaleMiddle AgedPatient TransferProspective StudiesTime FactorsHEALTH ECONOMICS

Identifiers

PMID25270854
PMCPMC4179416

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.