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Reorganisation and development of a consultant-led cardiology service leads to substantial reductions in length of stay, all-cause inhospital and 30-day post-discharge mortality in acute coronary syndromes
  1. R Schofield,
  2. MJNK Chuen,
  3. R Sankaranarayanan,
  4. C Crowe,
  5. K Helm,
  6. J McDonald,
  7. RK Singh,
  8. KP Balachandran
  1. Royal Blackburn Hospital, East Lancashire NHS Trust, Blackburn, UK

Abstract

Background East Lancashire Hospitals NHS Trust (ELHT) reorganised its services in October 2007 with all acute admissions sent to one site (Royal Blackburn Hospital). This allowed the development of a 24/7 consultant-led cardiology service (three newly appointed interventional and three non-interventional cardiologists). Management of a new 10-bedded coronary care unit was taken over by the cardiologists who also provided a daily ward round in the medical admissions unit and the general cardiology ward. The emphasis was on the early recognition of the high to intermediate risk patients who were most likely to benefit from assessment and management directed by consultant cardiologists.

Methods We performed an audit of all patients admitted with acute coronary syndromes (ACS) between two periods: group 1—between October 2006 and September 2007 and group 2—between October 2007 and September 2008. The data were obtained from the MINAP database. We looked at the following endpoints: length of stay, inhospital and 30-day postdischarge all-cause mortality.

Results 633 patients were admitted between 2006 and 2007 and 748 patients between 2007 and 2008. The mean age was higher (70.3 vs 68.2 years; p = 0.006) and there was a greater proportion of women (42% vs 35%; p = 0.008) in group 1. There was no difference between the two groups in terms of the number of patients with diabetes or hypertension at admission. There was a significant reduction in the length of stay from a median (interquartile range) of 7 days (5–11) to 5 days (3–9); p<0.0001. The number of transfers to the regional tertiary centre for acute angiography increased from 95 (15%) to 241 (32.2%); p<0.0001. The inhospital mortality reduced from 15.6% (n  =  99) to 7.2% (n  =  54); p<0.0001. The 30-day postdischarge mortality reduced from 19.4% (n  =  123) to 10.2% (n  =  76); p<0.0001. The reductions in mortality and length of stay remained significant after adjustment for demographic and risk factor variables.

Conclusion The development of a modern and comprehensive consultant cardiologist-led service directed towards the early recognition and appropriate management of patients admitted with ACS is associated with impressive reductions in all-cause mortality. This improvement in outcomes occurred with an equally impressive reduction in hospital length of stay.

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