Hall, M orcid.org/0000-0003-1246-2627, Bebb, OJ orcid.org/0000-0003-0974-9109, Dondo, TB et al. (11 more authors) (2018) Guideline-indicated treatments and diagnostics, GRACE risk score, and survival for non-ST elevation myocardial infarction. European Heart Journal, 39 (42). pp. 3798-3806. ISSN 0195-668X
Abstract
Aim: To investigate whether improved survival from NSTEMI, according to GRACE risk score, was associated with guideline-indicated treatments and diagnostics, and persisted after hospital discharge.
Methods and results: National cohort study (n=389,507 patients, n=232 hospitals, MINAP registry), 2003-13. The primary outcome was adjusted all-cause survival estimated using flexible parametric survival modelling with time-varying covariates over a median follow-up of 2.3-years. Receipt of all eligible treatments (optimal care) was inversely related to risk status: 25.6% in low, 18.6% in intermediate and 11.5% in high risk NSTEMI. At 30 days, the use of optimal care was associated with improved survival among high (adjusted hazard ratio [aHR]=0.66 [95% CI 0.53-0.86], difference in absolute mortality rate per 100 patients [AMR/100] –0.19 [95% CI –0.29 to –0.08]), and intermediate (aHR=0.74 [95% CI 0.62-0.92]; AMR/100 –0.15 [95% CI –0.23 to –0.08]) risk NSTEMI. At the end of follow-up (8.4 years), the significant association between the use of all eligible guideline-indicated treatments and improved survival remained only for high risk NSTEMI (aHR=0.66 [95% CI 0.50-0.96]; AMR/100= –0.03 [95% CI –0.06 to –0.01]). For low risk NSTEMI, there was no association between the use of optimal care and improved survival at 30 days (aHR=0.92 [95% CI 0.69-1.38] and at 8.4 years (aHR=0.71 [95% CI 0.39-3.74]).
Conclusions: Optimal use of guideline-indicated care for NSTEMI was associated with greater survival gains with increasing GRACE risk, but its use decreased with increasing GRACE risk.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | (c) The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
Keywords: | Non-ST-elevation myocardial infarction; Quality of care; Mortality; GRACE risk score |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) > Clinical & Population Science Dept (Leeds) |
Funding Information: | Funder Grant number British Heart Foundation PG/13/81/30474 |
Depositing User: | Symplectic Publications |
Date Deposited: | 14 Aug 2018 09:56 |
Last Modified: | 30 May 2023 22:22 |
Status: | Published |
Publisher: | Oxford University Press |
Identification Number: | 10.1093/eurheartj/ehy517 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:134544 |