Sex-based analysis of NSTEMI processes of care and outcomes by hospital: a nationwide cohort study

Figures

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  Figure 1. STROBE diagram detailing exclusion criteria.

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  Figure 2. Risk standardized mortality rate (RSMR) for individual National Health Service (NHS) trusts patients plotted against mean Opportunity Based Quality Indicator Score (OBQI) for females. Coefficient −0.22, (95% CI; −0.278 to −0.168), R2 = 0.22, P < 0.001. RSMR, risk-standardized mortality rate. Adjusted for age, ethnicity, family history of coronary heart diseases, ischaemic ECG changes, history of heart failure, left ventricle systolic dysfunction, hypercholesterolaemia, history of myocardial infarction, history of cerebrovascular accident, history of peripheral vascular disease, hypertension, smoking, asthma/chronic obstructive pulmonary disease and admission under consultant cardiologist. Mortality refers to all-cause inpatient mortality only. Opportunity based QI [The score consisted of six evidence-based processes of care: the prescription of aspirin, thienopyridine inhibitor, β-blocker, angiotensin converting enzyme inhibitor (ACEi), HMG CoA reductase enzyme inhibitor (statin) and enrolment onto a cardiac rehabilitation programme at the time of discharge]. The OBCS reflects the number of care opportunities fulfilled at each hospital (numerator) divided by the number of…

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  Figure 3. Risk standardized mortality rate (RSMR) for individual National Health Service) (NHS) trusts patients plotted against mean Opportunity Based Quality Indicator score (OBQI) for males. Coefficient −0.13, (95% CI; −0.190 to −0.076), R2 = 0.08, P < 0.001. Opportunity based QI [The score consisted of six evidence-based processes of care: the prescription of aspirin, thienopyridine inhibitor, β-blocker, angiotensin converting enzyme inhibitor (ACEi), HMG CoA reductase enzyme inhibitor (statin) and enrolment onto a cardiac rehabilitation programme at the time of discharge]. The OBCS reflects the number of care opportunities fulfilled at each hospital (numerator) divided by the number of opportunities to provide care (denominator). Excluded from both numerator and denominator were interventions that were contra-indicated, not applicable, not indicated in, or declined by, individual patients.

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  Figure 4. Heat map of UK Clinical Commissioning Groups (CCGs) according to mean Opportunity Based Quality Indicator (OBQI) score. Opportunity based QI (The score consisted of six evidence-based processes of care: the prescription of aspirin, thienopyridine inhibitor, β-blocker, angiotensin converting enzyme inhibitor (ACEi), HMG CoA reductase enzyme inhibitor (statin) and enrolment onto a cardiac rehabilitation programme at the time of discharge). The OBCS reflects the number of care opportunities fulfilled at each hospital (numerator) divided by the number of opportunities to provide care (denominator). Excluded from both numerator and denominator were interventions that were contra-indicated, not applicable, not indicated in, or declined by, individual patients.

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  Figure 5. Heat maps of UK Clinical Commissioning Groups according to mean opportunity based quality indicator score according to sex. (A) Heat map of UK Clinical Commissioning Groups (CCGs) according to mean Opportunity Based Quality Indicator (OBQI) score for females. (B) Heat map of UK Clinical Commissioning Groups (CCGs) according to mean Opportunity Based Quality Indicator (OBQI) score for males. (C) Heat map of UK Clinical Commissioning Groups (CCGs) according to difference in mean Opportunity Based Quality Indicator (OBQI) score between males and females (male score minus female score). The mean difference in OBQI is displayed, calculated by male score minus female score. Opportunity based QI [The score consisted of six evidence-based processes of care: the prescription of aspirin, thienopyridine inhibitor, β-blocker, angiotensin converting enzyme inhibitor (ACEi), HMG CoA reductase enzyme inhibitor (statin) and enrolment onto a cardiac rehabilitation programme at the time of discharge]. The OBCS reflects the number of care opportunities fulfilled at each hospital (numerator) divided by the number of opportunities to provide care (denominator). Excluded from both numerator and…