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Original research
Unscheduled care pathways in patients with myocardial infarction in Scotland
  1. Peter Hodgins1,
  2. Megan McMinn1,
  3. Anoop Shah2,
  4. Matthew J Reed3,
  5. Stewart Mercer1,
  6. Bruce Guthrie1
  1. 1Centre for Population Health Sciences, Usher Institute, The University of Edinburgh, Edinburgh, UK
  2. 2Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  3. 3Usher Institute, The University of Edinburgh, Edinburgh, UK
  1. Correspondence to Professor Bruce Guthrie, Centre for Population Health Sciences, Usher Institute, The University of Edinburgh, Edinburgh EH8 9AG, UK; bruce.guthrie{at}ed.ac.uk

Abstract

Objective Treatment of acute myocardial infarction (MI) requires rapid transfer of people with chest pain to hospital, however, unscheduled care pathways vary in their directness (the minimal number of contacts to hospital admission). The aim was to examine unscheduled care pathways and the associations with mortality in people admitted with MI.

Methods Retrospective population study of all people admitted to Scottish hospitals with a diagnosis of MI between 1 January 2015 and 31 December 2017. Linked data for all National Health Service Scotland unscheduled care services (NHS24 telephone triage service, primary care out of hours, ambulance, emergency department (ED)) was used to define continuous unscheduled care pathways (pathways), which were categorised by initial contact, and whether they were ‘direct’ (had minimum number of contacts between first contact and admission). Analysis estimated ORs and 95% CIs in adjusted models in which all covariates were included.

Results 26 325 people admitted with MI (63.1% men, 61.6% aged 65+ years), of whom 5.6% died from coronary heart disease within 28 days. For 47.0%, the first unscheduled care contact was ambulance, 23.3% attended ED directly and 18.7% called telephone triage. 92.1% of pathways were direct. Pathways starting with telephone triage were more likely to be indirect compared with other initial contacts (adjusted OR (aOR) 1.97, 95% CI 1.61 to 2.40). Compared to direct pathways, indirect pathways starting with telephone triage were associated with higher mortality (aOR 1.97, 95% CI 1.61 to 2.40) as were indirect pathways starting with another service (aOR 1.55, 95% CI 1.19 to 2.01), but not direct pathways starting with telephone triage (aOR 0.87, 95% CI 0.74 to 1.02).

Conclusion Unscheduled care pathways leading to admission with MI in Scotland are usually direct, but those starting with telephone triage were more commonly indirect. Those indirect pathways were associated with higher mortality.

  • Myocardial Infarction
  • Telemedicine
  • Quality of Health Care
  • Delivery of Health Care

Data availability statement

Data are not publicly available but may be obtained from the Data Controller - Public Health Scotland electronic Data Research and Innovation Service (eDRIS).

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Data availability statement

Data are not publicly available but may be obtained from the Data Controller - Public Health Scotland electronic Data Research and Innovation Service (eDRIS).

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Footnotes

  • Twitter @PeteHodgins

  • Contributors PH and BG conceived the idea for the study and were the main authors. MM provided data management and statistical analysis. Expert review was provided by AS, MJR and SM. BG is responsible for the overall content as guarantor.

  • Funding The study was funded by the University of Edinburgh.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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