The impact of the National Service Framework for Coronary Artery Disease on treatment and outcome of patients with acute coronary syndromes

John J Graham ¹, Adam D Timmis ¹, Jackie Cooper ², Sanjay Ramdany ¹, Andrew Deaner ¹, Kulasegaram Ranjadayalan ³ and Charles Knight ^1*

¹ London Chest Hospital, United Kingdom
² Rayne Institute, UCL, London, United Kingdom
³ Newham General Hospital, London., United Kingdom

^* To whom correspondence should be addressed. E-mail: knightlch{at}aol.com.

Accepted 12 May 2005

Abstract

Objective: To evaluate the impact the National Service Framework (NSF) for Coronary Heart Disease (CHD) has had on emergency treatment and outcomes in patients presenting with acute coronary syndromes.

Design: Retrospective cohort study.

Setting: Coronary care units of 2 district general hospitals.

Results: Data from 3371 patients were recorded, 1993 patients in the 27 months prior to NSF and 1378 patients in the 24 months after. Following the introduction of the NSF there was a significant reduction in in-hospital mortality (95 patients [4.8%] versus 43 [3.2%], p=0.02). This was associated with reduction in the development of Q-wave myocardial infarction (40.6% versus 33.3%, p<0.0001) and in the incidence of left ventricular failure (15.9% versus 12.3%, p=0.003). The proportion of patients receiving thrombolysis increased (69.4% versus 84.7%, p<0.0001) with a decrease in the time taken to receive it (proportion thrombolysed within twenty minutes 12.1% versus 26.6%, p<0.0001). There were improvements in the prescription of beta-blockers (51.9% versus 65.8%, p<0.0001), ACE-inhibitors (37% versus 66.4%, p<0.0001) and HMGCoA reductase inhibitors (55.2% versus 72.7%, p<0.0001) and an increase in the proportion of patients referred for invasive investigation (18.3% versus 27.0%, p<0.0001). Trend analysis showed that improvements in mortality and thrombolysis were directly associated with publication of the NSF whereas the improvements seen in prescription of beta blockers and statins were the continuation of pre-existing trends.

Conclusions: In the two years that followed publication of the NSF there were improvements in the initial treatment and outcome of patients presenting with acute coronary syndromes. Some of the improvements can be attributed to the NSF but others are continuations of pre-existing trends.

Keywords: ACS, NSF, outcomes, treatment

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