Unscheduled care pathways in patients with myocardial infarction in Scotland

Abstract

ObjectiveTreatment 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.MethodsRetrospective 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.Results26 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).ConclusionUnscheduled 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.

Should we always call 911/999 to get it right first time in suspected myocardial infarction?

“…To address this question, Hodgins and colleagues performed a retrospective nationwide analysis using data linkage from Scottish healthcare records of 26 325 patients admitted with myocardial infarction over 2 years 4. Using International Classification of Disease 10th Revision (ICD) codes (I21 and I22) to capture the diagnosis of myocardial infarction, they were able to link multiple datasets from the Scottish National Health Service telephone triage service (NHS24), the Scottish Ambulance Service, out-of-hours primary care, emergency departments and acute hospital admissions units to ascertain the patient pathway which resulted in an acute hospital admission for myocardial infarction.…”

Heartbeat: treatment delays with telephone triage for acute myocardial infarction

“…Although some patients present directly to the emergency department or call an ambulance, others use telephone triage services which became the preferred route for receiving care in the UK during the COVID-19 pandemic. In order to identify issues that might lead to treatment delays with the telephone triage approach, Hodgins and colleagues1 performed a retrospective study of all people admitted to Scottish hospitals with a diagnosis of MI between 1 January 2015 and 31 December 2017. In these 26 325 patients (63.1% men, 61.6% aged 65+ years), 47.0% called an ambulance, 23.3% presented directly to the emergency department and 18.7% called telephone triage.…”