Evidence map›Paper›PMID 27406646›Full record

ArticleBMJ open2016

Geographic variation in the treatment of non-ST-segment myocardial infarction in the English National Health Service: a cohort study.

T B Dondo, M Hall, A D Timmis, A T Yan, P D Batin, G Oliver, O A Alabas, P Norman, J E Deanfield, K Bloor and 2 more

Registry-linked trialOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02436187 (Guideline Recommended Care and Excess Mortality for Non ST-elevation Myocardial Infarction), which is not on this map. Cited by 13 papers.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed
2.9field-weighted citation impact, top 8% 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.

NCT02436187 completednot on this map

Guideline Recommended Care and Excess Mortality for Non ST-elevation Myocardial Infarction : A National Cohort Study

Typeobservational_patient_registrySponsorUniversity of LeedsRan2003 to 2013Enrolled389,057ConditionsNon ST-elevation Myocardial Infarction
3 · Its place in the literature

Who cites it

13 citing papers in PubMed, 24 citations in OpenAlex.

  1. Article
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  3. Review
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  8. Observational
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  13. Why report outcomes when process measures will suffice?European heart journal. Quality of care & clinical outcomes · 2017
    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

12 authors at 7 institutions in 2 countries.

T B DondoLeeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK.
M HallLeeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK.
A D TimmisThe National Institute for Health Biomedical Research Unit, Barts Health, London, UK.
A T YanDepartment of Medicine, University of Toronto, Toronto, Ontario, Canada.
P D BatinDepartment of Cardiology, The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK.
G OliverNational Health Service cardiac service user, West Yorkshire, UK.
O A AlabasLeeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK.
P NormanSchool of Geography, University of Leeds, Leeds, UK.
J E DeanfieldNational Institute for Cardiovascular Outcomes Research, University College London, London, UK.
K BloorDepartment of Health Sciences, University of York, York, UK.
H HemingwayThe Farr Institute, University College London, London, UK.
C P GaleLeeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK York Teaching Hospital NHS Foundation Trust, York, UK.
University College London · GBMid Yorkshire Hospitals NHS Trust · GBNational Health Service · GBUniversity of Leeds · GBUniversity of Toronto · CAUniversity of York · GBYork Teaching Hospital NHS Foundation Trust · GB

Funding

British Heart Foundation PG/13/81/3047British Heart Foundation PG/13/81/30474Medical Research Council G0902393Medical Research Council MC_PC_13041Medical Research Council MR/K006584/1
6 · The paper itself

Abstract

objectivesTo investigate geographic variation in guideline-indicated treatments for non-ST-elevation myocardial infarction (NSTEMI) in the English National Health Service (NHS).

designCohort study using registry data from the Myocardial Ischaemia National Audit Project.

settingAll Clinical Commissioning Groups (CCGs) (n=211) in the English NHS.

participants357 228 patients with NSTEMI between 1 January 2003 and 30 June 2013.

main outcome measureProportion of eligible NSTEMI who received all eligible guideline-indicated treatments (optimal care) according to the date of guideline publication.

resultsThe proportion of NSTEMI who received optimal care was low (48 257/357 228; 13.5%) and varied between CCGs (median 12.8%, IQR 0.7-18.1%). The greatest geographic variation was for aldosterone antagonists (16.7%, 0.0-40.0%) and least for use of an ECG (96.7%, 92.5-98.7%). The highest rates of care were for acute aspirin (median 92.8%, IQR 88.6-97.1%), and aspirin (90.1%, 85.1-93.3%) and statins (86.4%, 82.3-91.2%) at hospital discharge. The lowest rates were for smoking cessation advice (median 11.6%, IQR 8.7-16.6%), dietary advice (32.4%, 23.9-41.7%) and the prescription of P2Y12 inhibitors (39.7%, 32.4-46.9%). After adjustment for case mix, nearly all (99.6%) of the variation was due to between-hospital differences (median 64.7%, IQR 57.4-70.0%; between-hospital variance: 1.92, 95% CI 1.51 to 2.44; interclass correlation 0.996, 95% CI 0.976 to 0.999).

conclusionsAcross the English NHS, the optimal use of guideline-indicated treatments for NSTEMI was low. Variation in the use of specific treatments for NSTEMI was mostly explained by between-hospital differences in care. Performance-based commissioning may increase the use of NSTEMI treatments and, therefore, reduce premature cardiovascular deaths. TRIAL REGISTRATION NUMBER: NCT02436187.

Indexed as

Guideline AdherenceHealthcare DisparitiesHospitalsResidence CharacteristicsState MedicineAgedAged, 80 and overAspirinCohort StudiesEchocardiographyEnglandFemaleHumansMaleMiddle AgedMineralocorticoid Receptor AntagonistsAspirinMineralocorticoid Receptor AntagonistsPlatelet Aggregation InhibitorsPurinergic P2Y Receptor AntagonistsClinical Commissioning GroupsGeographic variationInequalitiesMINAPNational Health ServiceNSTEMI

Identifiers

PMID27406646
PMCPMC4947744
OpenAlexW2411102779

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

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.