Management of unstable angina and non-ST-elevation myocardial infarction: do cardiologists do it better? A comparison of secondary and tertiary centre management in New Zealand

N Z Med J. 2004 May 21;117(1194):U890.

Abstract

Background: Internationally, differences have been noted in how specialist cardiologists and general physicians manage acute coronary syndromes (ACS). Whether a similar practice difference exists in New Zealand is unclear.

Aim: To test the hypothesis that management differences exist between cardiologists and general physicians in patients presenting with a non-ST-segment elevation acute coronary syndrome in a New Zealand setting-and whether these differences (if present) impact on patient outcome.

Methods: A retrospective chart review of 324 consecutive patients presenting with a non-ST-segment elevation acute coronary syndrome to Taranaki Base and Waikato Hospitals from 1 January 1999 was undertaken. Patients in Taranaki were managed by general physicians and in Waikato they were managed by cardiologists.

Results: Patients presenting to Taranaki Base Hospital were more likely to have high-risk ECG changes with ST-segment depression noted in 34.4% of patients there compared to 16.8% of patients in Waikato (p<0.001). Medical management during patient stabilisation was similar in Taranaki and Waikato with high use of anti-thrombotic (89%) and anti-platelet therapy (94%), respectively. However angiography (5.1% versus 23.4%; p=0.0045) and revascularisation procedures (4% versus 16.7%; p=0.0002) were performed less frequently in Taranaki. No significant difference was noted in mortality at 6 months (9.6% in Waikato versus 13.4% in Taranaki; p=0.4) Readmission rates were also similar; occurring overall in approximately one-quarter of the study population.

Conclusion: In New Zealand, differences exist in how cardiologists and general physicians manage non-ST-elevation acute coronary syndrome. In particular, the low referral rates for angiography by general physicians is of concern and requires correction as current best-practice guidelines suggest high-risk patients are disadvantaged by a conservative approach to management.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Angina, Unstable / drug therapy
  • Angina, Unstable / surgery
  • Angina, Unstable / therapy*
  • Cardiac Care Facilities / standards
  • Cardiac Care Facilities / statistics & numerical data
  • Cardiology / methods*
  • Cardiology Service, Hospital / statistics & numerical data
  • Coronary Angiography / statistics & numerical data
  • Coronary Care Units / statistics & numerical data
  • Delivery of Health Care / standards
  • Delivery of Health Care / statistics & numerical data
  • Electroencephalography / statistics & numerical data
  • Family Practice / methods*
  • Female
  • Humans
  • Male
  • Medical Records
  • Middle Aged
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / surgery
  • Myocardial Infarction / therapy*
  • New Zealand
  • Outcome Assessment, Health Care
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Referral and Consultation / statistics & numerical data
  • Retrospective Studies
  • Thrombolytic Therapy / statistics & numerical data