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Patients admitted to a district general hospital with unstable angina are disadvantaged compared with those admitted to a tertiary centre

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Patients with unstable angina or non-ST elevation myocardial infarction (NSTEMI) admitted to a district general hospital (DGH) waited over two and a half times longer for angiography and twice as long for revascularisation than those admitted to the local tertiary cardiac centre.

As the conditions carry a significant mortality and trials have shown prognostic benefit for early investigation and revascularisation in “high risk” patients with these diagnoses, equity of access to care should be a cornerstone of the NHS.

The authors studied 95 patients admitted to DGHs who were subsequently transferred to the Manchester, UK, Heart Centre at Manchester Royal Infirmary (MRI). They compared their progress with a similar number admitted directly to the Infirmary under the care of general physicians (internists) but later transferred to the cardiac team. There were no important baseline differences, except that the DGH patients were less likely to have had a previous revascularisation procedure.

The greatest part of the delay was while patients waited for transfer. Selection bias resulted from the perceived advantage of an MRI patient transferring to cardiac services thereby freeing up a much needed general medical bed. The principle of equal access demands that tertiary centres should be allowed to work independently of bed pressures created elsewhere in their parent hospital.