The impact of geographical distances to coronary angiography laboratories on the patient evaluation pathways in patients with suspected coronary artery disease. Results from a population-based study in Hungary

Abstract

IntroductionCoronary artery disease (CAD) has been a leading cause of death in the western world for the last few decades, despite significant improvements in treatment and management. Diagnostic algorithms for the evaluation of patients with suspected CAD are based on available guidelines.AimTo evaluate the impact of geographical distances to coronary angiography laboratories on the patient evaluation pathways in patients with suspected CAD, from a population-based study in Hungary.Material and methodsDepersonalised data of 29,202 patients identified by their pseudo-social security number were analysed. All patients underwent coronary angiography as an initial direct invasive investigation (DI) following an at least half-year-long stable period between 1 January 2004 and 31 December 2008.ResultsOne hundred and thirty-five dominant primary cardiology centres (PCC) have been identified, from which 85 proved to have sample size more than 100 DIs in tertiary cardiology centres (TCC). The frequency of DIs showed a close correlation with PCC-TCC distances (r = –0.44, p < 0.001). A negative correlation could be demonstrated between the age of patients and PCC-TCC distances (r = –0.45, p < 0.001). Without significant change in the absolute mortality, the relative mortality increased with the increase in PCC-TCC distance (r = 0.25, p < 0.05).ConclusionsThe PCC-TCC distance has an important effect on patient pathways in subjects with suspected CAD.

A comparison of rescue and primary percutaneous coronary interventions for acute ST elevation myocardial infarction

“…Based on this comparative analysis between rescue and primary PCI, we conclude that patients presenting with early onset AMI treated with either strategy, had equal procedural success as well as similar in-hospital death rates, thereby further advocating the use of rescue PCI as a viable option in rural areas, where immediate fibrinolysis can buy time until PCI facility access is gained in more urban areas 33 . Future research should be focused on large population studies and to compare the long term follow up results as well as the relationship between patients’ mortality rates with transfer time from rural hospitals 34 …”

“… 33 Future research should be focused on large population studies and to compare the long term follow up results as well as the relationship between patients’ mortality rates with transfer time from rural hospitals. 34 …”

Correlation Clustering of Stable Angina Clinical Care Patterns for 506 Thousand Patients

“…If suitable, innovative data mining and analysis methods are employed to leverage this data; the resource allocation and the overall quality of healthcare delivery can be improved. Our working group already evaluated earlier the characteristics of patients referred to the first investigation in different areas of the country [ 3 ] and documented the systematic bias due to factors like geographical distance to the invasive diagnostic centers [ 4 , 5 ] or local volume capacity of invasive diagnostics [ 6 ].…”