National variation in coronary angiography rates and timing after an acute coronary syndrome in New Zealand (ANZACS-QI 6)

N Z Med J. 2016 Jan 8;129(1428):66-78.

Abstract

Aim: The New Zealand Cardiac Clinical Network and the Ministry of Health recommend a "3-day door-to-catheter target" for acute coronary syndromes (ACS) admissions, requiring that at least 70% of ACS patients referred for invasive coronary angiography (ICA) undergo this within 3 days of hospital admission. We assessed the variability in use of ICA, timing of ICA, and duration of hospital admission across New Zealand District Health Boards (DHBs).

Methods: All patients admitted to all New Zealand public hospitals with suspected ACS undergoing ICA over 1 year ending November 2014 had demographic, risk factor, and diagnostic data collected prospectively using the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry. Complete datasets were available in 7,988 (98.4%) patients. DHBs were categorised as those able to perform percutaneous coronary intervention on-site (intervention-capable) or not.

Results: There was a near two-fold variation between DHBs in the age standardised rate (ASR) of ICA ranging from 16.8 per 10,000 to 34.1 per 10,000 population (New Zealand rate; 27.9 per 10,000). Patients in intervention-capable DHBs had a 30% higher ASR of ICA. The proportion of ACS patients meeting the 3-day target ranged from 56.7% to 92.9% (New Zealand; 76.4%). Those in intervention-capable DHBs were more likely to meet the target (78.7% vs 68.0%, p<0.0001) and spent 0.84 days (p<.0001) less in hospital.

Conclusions: There is a considerable variation in the rate and timing of ICA in New Zealand. Patients with ACS admitted to DHBs without interventional-capability are disadvantaged. New initiatives to correct this discrepancy are needed.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / epidemiology*
  • Acute Coronary Syndrome / therapy
  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Coronary Angiography / statistics & numerical data*
  • Coronary Artery Disease / epidemiology
  • Coronary Occlusion / epidemiology
  • Female
  • Hospitalization / statistics & numerical data
  • Hospitals, Public
  • Humans
  • Male
  • Middle Aged
  • New Zealand / epidemiology
  • Patient Transfer / statistics & numerical data
  • Percutaneous Coronary Intervention / statistics & numerical data
  • Registries
  • Sex Distribution
  • Time-to-Treatment / statistics & numerical data*
  • Young Adult