Evidence map›Paper›PMID 27179739›Full record

ArticleAmerican heart journal2016

Do stable non-ST-segment elevation acute coronary syndromes require admission to coronary care units?

Sean van Diepen, Meng Lin, Jeffrey A Bakal, Finlay A McAlister, Padma Kaul, Jason N Katz, Christopher B Fordyce, Danielle A Southern, Michelle M Graham, Stephen B Wilton and 3 more

Abstract read
PubMed Publisher
In one paragraph

Article in American heart journal, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 1 pooled it
–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

14 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Efficacy and safety of proton pump inhibitors versus histamine-2 receptor blockers in the cardiac surgical population: insights from the PEPTIC trial.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2022
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

Sean van DiepenDivisions of Critical Care and Cardiology, University of Alberta, Edmonton, AB, Canada; Canadian Vigour Center, Edmonton, AB, Canada. Electronic address: sv9@ualberta.ca.
Meng LinAlberta SPOR Support Unit, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Jeffrey A BakalCanadian Vigour Center, Edmonton, AB, Canada; Alberta SPOR Support Unit, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Finlay A McAlisterCanadian Vigour Center, Edmonton, AB, Canada; Alberta SPOR Support Unit, Department of Medicine, University of Alberta, Edmonton, AB, Canada; Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Padma KaulCanadian Vigour Center, Edmonton, AB, Canada.
Jason N KatzDivisions of Cardiology and Pulmonary/Critical Care Medicine, University of North Carolina, Chapel Hill, NC.
Christopher B FordyceDuke Clinical Research Institute, Duke University Medical Center, Durham, NC.
Danielle A SouthernO'Brien Institute for Public Health and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Michelle M GrahamDivision of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Stephen B WiltonLibin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.
L Kristin NewbyDuke Clinical Research Institute, Duke University Medical Center, Durham, NC.
Christopher B GrangerDuke Clinical Research Institute, Duke University Medical Center, Durham, NC.
Justin A EzekowitzCanadian Vigour Center, Edmonton, AB, Canada; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundClinical practice guidelines recommend admitting patients with stable non-ST-segment elevation acute coronary syndrome (NSTE ACS) to telemetry units, yet up to two-thirds of patients are admitted to higher-acuity critical care units (CCUs). The outcomes of patients with stable NSTE ACS initially admitted to a CCU vs a cardiology ward with telemetry have not been described.

methodsWe used population-based data of 7,869 patients hospitalized with NSTE ACS admitted to hospitals in Alberta, Canada, between April 1, 2007, and March 31, 2013. We compared outcomes among patients initially admitted to a CCU (n=5,141) with those admitted to cardiology telemetry wards (n=2,728).

resultsPatients admitted to cardiology telemetry wards were older (median 69 vs 65years, P<.001) and more likely to be female (37.2% vs 32.1%, P<.001) and have a prior myocardial infarction (14.3% vs 11.5%, P<.001) compared with patients admitted to a CCU. Patients admitted directly to cardiology telemetry wards had similar hospital stays (6.2 vs 5.7days, P=.29) and fewer cardiac procedures (40.3% vs 48.5%, P<.001) compared with patients initially admitted to CCUs. There were no differences in the frequency of in-hospital mortality (1.3% vs 1.2%, adjusted odds ratio [aOR] 1.57, 95% CI 0.98-2.52), cardiac arrest (0.7% vs 0.9%, aOR 1.37, 95% CI 0.94-2.00), 30-day all-cause mortality (1.6% vs 1.5%, aOR 1.50, 95% CI 0.82-2.75), or 30-day all-cause postdischarge readmission (10.6% vs 10.8%, aOR 1.07, 95% CI 0.90-1.28) between cardiology telemetry ward and CCU patients. Results were similar across low-, intermediate-, and high-risk Duke Jeopardy Scores, and in patients with non-ST-segment myocardial infarction or unstable angina.

conclusionsThere were no differences in clinical outcomes observed between patients with NSTE ACS initially admitted to a ward or a CCU. These findings suggest that stable NSTE ACS may be managed appropriately on telemetry wards and presents an opportunity to reduce hospital costs and critical care capacity strain.

Indexed as

Coronary Care UnitsNon-ST Elevated Myocardial InfarctionAgedCanadaCosts and Cost AnalysisDisease ManagementElectrocardiographyFemaleHospital MortalityHumansLength of StayMaleMiddle AgedOutcome and Process Assessment, Health CarePatient AcuityPatient Admission

Identifiers

PMID27179739

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.