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Influence of distance from home to invasive centre on invasive treatment after acute coronary syndrome: a nationwide study of 24 910 patients
  1. Anders Hvelplund1,2,3,
  2. Søren Galatius2,
  3. Mette Madsen4,
  4. Jeppe Nørgaard Rasmussen4,
  5. Rikke Sørensen2,
  6. Emil Loldrup Fosbøl2,
  7. Jan Kyst Madsen2,3,
  8. Søren Rasmussen1,
  9. Erik Jørgensen5,
  10. Leif Thuesen6,
  11. Christian Holflod Møller7,
  12. Steen Zabell Abildstrøm1,3,8
  1. 1National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
  2. 2Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
  3. 3Danish Heart Registry,
  4. 4Department of Public Health, University of Copenhagen, Copenhagen, Denmark
  5. 5Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
  6. 6Department of Cardiology, Skejby Hospital, Aarhus University Hospital, Aarhus, Denmark
  7. 7Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
  8. 8Cardiovascular Research Unit, Department of Internal Medicine, Copenhagen University Hospital, Glostrup, Copenhagen, Denmark
  1. Correspondence to Dr Anders Hvelplund, National Institute of Public Health, Øster Farimagsgade 5A, DK1399, Copenhagen K, Denmark; ahv{at}


Objective To investigate whether distance from a patient's home to the nearest invasive centre influenced the invasive treatment strategy in acute coronary syndrome (ACS).

Methods This was an observational cohort study using nationwide registries involving 24 910 patients admitted with ACS (median age 67, range 30–90 years). All persons were grouped in tertiles according to the distance from their residence to the invasive centre. Cox proportional hazard models were applied to estimate the differences in coronary angiography and revascularisation rate within 60 days of admission according to the distance to the centre. The end points were coronary angiography and subsequent revascularisation.

Results Of 24 910 patients with a first ACS, 33% resided <21 km from one of the five invasive centres in Denmark, 33% lived between 21 and 64 km away and 34% lived >64 km away. The incidence of coronary angiography was 68% for long distance versus 77% for short distance (p<0.05), with an HR of 0.78 (95% CI 0.75 to 0.81, p<0.0001). Adjustment for patient characteristics such as age, sex, co-morbidity and socioeconomic status did not attenuate the difference (HR 0.74, 95% CI 0.71 to 0.77, p<0.0001). Furthermore, revascularisation in the subgroup examined with coronary angiography was less likely for those residing a long distance from the invasive centre compared with those living nearer (adjusted HR of 0.82 (95% CI 0.78 to 0.85, p<0.0001).

Conclusions In patients hospitalised with ACS, invasive examination and treatment were less likely the further away from an invasive centre the patients resided, thus equal and uniform invasive examination and treatment was not found.

  • Coronary angiography
  • coronary intervention
  • acute coronary syndrome
  • delivery of care
  • epidemiology

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  • Funding This work was supported by the Danish Heart Foundation.

  • Competing interests None.

  • Ethics approval The Danish National Board of Health, the Danish Data Protection Agency and the Board of the Danish Heart Registry all approved the project, which was conducted in accordance with the current rules of ethics and legislature. Registry-based studies do not require ethics approval in Denmark.

  • Provenance and peer review Not commissioned; externally peer reviewed.