Evidence map›Paper›PMID 26732182›Full record

ArticleHeart (British Cardiac Society)2016

Patient and hospital determinants of primary percutaneous coronary intervention in England, 2003-2013.

M Hall, K Laut, T B Dondo, O A Alabas, R A Brogan, N Gutacker, R Cookson, P Norman, A Timmis, M de Belder and 3 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Heart (British Cardiac Society), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed
6.1field-weighted citation impact, top 3% of its field
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

17 citing papers in PubMed, 39 citations in OpenAlex.

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  15. Why report outcomes when process measures will suffice?European heart journal. Quality of care & clinical outcomes · 2017
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 6 institutions in 1 country.

M HallLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
K LautLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
T B DondoLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
O A AlabasLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
R A BroganLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK York Teaching Hospital NHS Foundation Trust, York, UK.
N GutackerCentre for Health Economics, University of York, York, UK.
R CooksonCentre for Health Economics, University of York, York, UK.
P NormanSchool of Geography, University of Leeds, Leeds, UK.
A TimmisNIHR Biomedical Research Unit at Barts Health, Queen Mary University, London, UK.
M de BelderThe James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.
P F LudmanQueen Elizabeth Hospital, Birmingham, UK.
C P GaleLeeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK York Teaching Hospital NHS Foundation Trust, York, UK.
National Institute for Cardiovascular Outcomes Research (NICOR)
University of Leeds · GBUniversity of York · GBYork Teaching Hospital NHS Foundation Trust · GBBarts Health NHS Trust · GBJames Cook University Hospital · GBQueen Elizabeth Hospital Birmingham · GB

Funding

British Heart Foundation PG/13/81/30474Department of Health SRF-2013-06-015Medical Research Council MR/K006584/1
6 · The paper itself

Abstract

objectivePrimary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is insufficiently implemented in many countries. We investigated patient and hospital characteristics associated with PPCI utilisation.

methodsWhole country registry data (MINAP, Myocardial Ischaemia National Audit Project) comprising PPCI-capable National Health Service trusts in England (84 hospital trusts; 92 350 hospitalisations; 90 489 patients), 2003-2013. Multilevel Poisson regression modelled the relationship between incidence rate ratios (IRR) of PPCI and patient and trust-level factors.

resultsOverall, standardised rates of PPCI increased from 0.01% to 86.3% (2003-2013). While, on average, there was a yearly increase in PPCI utilisation of 30% (adjusted IRR 1.30, 95% CI 1.23 to 1.36), it varied substantially between trusts. PPCI rates were lower for patients with previous myocardial infarction (0.95, 0.93 to 0.98), heart failure (0.86, 0.81 to 0.92), angina (0.96, 0.94 to 0.98), diabetes (0.97, 0.95 to 0.99), chronic renal failure (0.89, 0.85 to 0.90), cerebrovascular disease (0.96, 0.93 to 0.99), age >80 years (0.87, 0.85 to 0.90), and travel distances >30 km (0.95, 0.93 to 0.98). PPCI rates were higher for patients with previous percutaneous coronary intervention (1.09, 1.05 to 1.12) and among trusts with >5 interventional cardiologists (1.30, 1.25 to 1.34), more visiting interventional cardiologists (1-5: 1.31, 1.26 to 1.36; ≥6: 1.42, 1.35 to 1.49), and a 24 h, 7-days-a-week PPCI service (2.69, 2.58 to 2.81). Half of the unexplained variation in PPCI rates was due to between-trust differences.

conclusionsFollowing an 8 year implementation phase, PPCI utilisation rates stabilised at 85%. However, older and sicker patients were less likely to receive PPCI and there remained between-trust variation in PPCI rates not attributable to differences in staffing levels. Compliance with clinical pathways for STEMI is needed to ensure more equitable quality of care.

Identifiers

PMID26732182
PMCPMC4752647
OpenAlexW2226146252

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.