Reducing time to angiography and hospital stay for patients with high-risk non-ST-elevation acute coronary syndrome: retrospective analysis of a paramedic-activated direct access pathway
Koganti, Sudheer Patel, N. Seraphim, A. Kotecha, T. Rakhit, Roby D.
Koganti, Sudheer
Patel, N.
Seraphim, A.
Kotecha, T.
Rakhit, Roby D.
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Abstract
Objective: To assess whether a novel ‘direct access
pathway’ (DAP) for the management of high-risk nonST-elevation acute coronary syndromes (NSTEACS) is
safe, results in ‘shorter time to intervention and shorter
admission times’. This pathway was developed locally
to enable London Ambulance Service to rapidly
transfer suspected high-risk NSTEACS from the
community to our regional heart attack centre for
consideration of early angiography.
Methods: This is a retrospective case–control analysis
of 289 patients comparing patients with high-risk
NSTEACS admitted via DAP with age-matched controls
from the standard pan-London high-risk ACS pathway
(PLP) and the conventional pathway (CP). The primary
end point of the study was time from admission to
coronary angiography/intervention. Secondary end
point was total length of hospital stay.
Results: Over a period of 43 months, 101 patients
were admitted by DAP, 109 matched patients by
PLP and 79 matched patients through CP. Median
times from admission to coronary angiography for
DAP, PLP and CP were 2.8 (1.5–9), 16.6 (6–50) and
60 (33–116) hours, respectively ( p<0.001). Median
length of hospital stay for DAP and PLP was similar at
3.0 (2.0–5.0) days in comparison to 5 (3–7) days for
CP ( p<0.001).
Conclusions: DAP resulted in a significant reduction
in time to angiography for patients with high-risk
NSTEACS when compared to existing pathways.
https://bmjopen.bmj.com/content/bmjopen/6/6/e010428.full.pdf
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
http://dx.doi.org/10.1136/bmjopen-2015-010428