Admission to a cardiac ward for NSTEMI was associated with lower odds of inhospital all-cause mortality (OR 0.75; 95% CI 0.70-0.81) and MACE (OR 0.84; 95% CI 0.78-0.91).
Cohort (n=337,155)
Yes
Does admission to a cardiac ward reduce inhospital mortality and MACE in patients with NSTEMI?
Admission of NSTEMI patients to a cardiac ward rather than a medical ward is associated with higher rates of guideline-directed management and significantly lower in-hospital mortality and MACE.
Effect estimate: OR 0.75 (95% CI 0.70-0.81)
AIMS: Little is known about the association between the type of admission ward and quality of care and outcomes for non-ST-segment elevation myocardial infarction (NSTEMI). METHODS AND RESULTS: We analysed data from 337 155 NSTEMI admissions between 2010 and 2017 in the UK Myocardial Ischaemia National Audit Project (MINAP) database. The cohort was dichotomised according to receipt of care either on a medical (n = 142,876) or cardiac ward, inclusive of acute cardiac wards and cardiac care unit (n = 194,279) on admission to hospital. Patients admitted to a cardiac ward were younger (median age 70 y vs. 75 y, P < 0.001), and less likely to be female (33% vs. 40%, P < 0.001). Independent factors associated with admission to a cardiac ward included ischaemic ECG changes (OR: 1.20, 95% CI: 1.18-1.23) and prior percutaneous coronary intervention (PCI) (OR: 1.19, 95% CI: 1.16-1.22). Patients admitted to a cardiac ward were more likely to receive optimal pharmacotherapy with statin (85% vs. 81%, P < 0.001) and dual antiplatelet therapy (DAPT) (91% vs. 88%, P < 0.001) on discharge, undergo invasive coronary angiography (78% vs. 59%, P < 0.001), and receive revascularisation in the form of PCI (52% vs. 36%, P < 0.001). Following multivariable logistic regression, the odds of inhospital all-cause mortality (OR: 0.75, 95% CI: 0.70-0.81) and major adverse cardiovascular events (MACE) (OR: 0.84, 95% CI: 0.78-0.91) were lower in patients admitted to a cardiac ward. CONCLUSION: Patients with NSTEMI admitted to a cardiac ward on admission were more likely to receive guideline directed management and had better clinical outcomes.
Moledina et al. (Sat,) conducted a cohort in non-ST-segment elevation myocardial infarction (NSTEMI) (n=337,155). Admission to a cardiac ward vs. Admission to a medical ward was evaluated on Inhospital all-cause mortality (OR 0.75, 95% CI 0.70-0.81). Admission to a cardiac ward for NSTEMI was associated with lower odds of inhospital all-cause mortality (OR 0.75; 95% CI 0.70-0.81) and MACE (OR 0.84; 95% CI 0.78-0.91).