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dc.contributor.authorKoganti, Sudheer
dc.contributor.authorPatel, N.
dc.contributor.authorSeraphim, A.
dc.contributor.authorKotecha, T.
dc.contributor.authorWhitbread, Mark
dc.contributor.authorRakhit, Roby D.
dc.date.accessioned2019-10-16T13:51:35Z
dc.date.available2019-10-16T13:51:35Z
dc.date.issued2016-06
dc.identifier.citationKoganti, S. et al, 2016. 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. BMJ Open, 6 (6), e010428.en_US
dc.identifier.issn2044-6055
dc.identifier.doi10.1136/bmjopen-2015-010428
dc.identifier.urihttp://hdl.handle.net/20.500.12417/380
dc.description.abstractObjective: 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
dc.language.isoenen_US
dc.subjectEmergency Medical Servicesen_US
dc.subjectAcute Coronary Syndromeen_US
dc.subjectCoronary Angiographyen_US
dc.subjectTime-to-Treatmenten_US
dc.subjectHospitalisationen_US
dc.titleReducing 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 pathwayen_US
dc.typeJournal Article/Review
dc.source.journaltitleBMJ Openen_US
dcterms.dateAccepted2019-07-24
rioxxterms.versionNAen_US
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden_US
rioxxterms.licenseref.startdate2019-07-24
refterms.panelUnspecifieden_US
refterms.dateFirstOnline2016-06
html.description.abstractObjective: 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-2015-010428en_US


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