Length of inpatient stay in patients with a suspected NSTEACS listed for invasive cardiac catheterisation
Background: Non-ST elevation acute coronary syndromes (NSTEACS), encompassing non-ST elevation myocardial infarction (NSTEMI) and unstable angina, are common causes of hospital admission and are associated with significant morbidity and mortality. Current guidelines recommend an early invasive strat...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
|
| Series: | Clinical Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1470211825001472 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Background: Non-ST elevation acute coronary syndromes (NSTEACS), encompassing non-ST elevation myocardial infarction (NSTEMI) and unstable angina, are common causes of hospital admission and are associated with significant morbidity and mortality. Current guidelines recommend an early invasive strategy particularly in high-risk patients.1,2 Delays in performing invasive angiography can prolong inpatient stays, potentially impacting patient outcomes and increasing healthcare costs. Identifying and addressing factors contributing to extended hospitalisation are essential to improve patient flow, optimise care delivery and ensure adherence to guideline-recommended outcomes. We aimed to investigate the length of stay and potential factors leading to its increase for inpatients with NSTEACS awaiting invasive angiography in a large tertiary hospital. Methods: We performed a retrospective analysis on patients presenting to Oxford University Hospitals with NSTEACS and who subsequently underwent coronary angiography between May 2021 and May 2023. We used the Cardiac IT database and electronic patient records to obtain data including age, gender, cardiac risk factors (diabetes, smoking, hypertension, family history and hypercholesterolaemia) as well as chief complaint and initial diagnostic investigations of acute coronary syndrome (ACS). We recorded initial presenting hospital site, and date and time of admission to the John Radcliffe Hospital, invasive angiography and discharge. We then calculated the door-to-needle time in hours and days, total length of stay in days and HEART score.3,4 Finally, we obtained data on the costs incurred for bed stays on medical and cardiology wards, diagnostic angiography and computed tomography (CT) scans. Results: We identified 1,479 patients who undergwent invasive coronary angiography at Oxford University Hospitals, from 1 May 2021 to 31 May 2023. Patients who underwent emergency (n=89) or elective (n=57) interventions were excluded. To avoid confounding resulting from logistical obstacles and ensure consistency of care, we excluded patients who underwent procedures on weekends and bank holidays (n=198), those who had repeat or bystander procedures (n=28) or were transferred from other hospitals (n=460). We then performed our analysis on the remaining 647 patients. 536(82.84%) patients were referred for inpatient angiogram from the John Radcliffe Hospital, while 111(17.15%) were referred from Horton General Hospital. 467(73%) were men, with median (range) age of 67 (30–93) years. Median door-to-needle time was 37 h (2.38 days; IQR 21–66), and median total length of stay in days was 5.93 (IQR 2.23–6.25). The mean (SD) HEART score was 6.9 (1.6). Clinical risk factors, demographics and biochemical findings are shown in Table 1.A total of 468 (72.3%) patients underwent percutaneous coronary intervention (PCI). The remaining 179 (27.6%) were either managed medically (n=97, 14.99%, median door-to-needle time 1.89 days) or considered for coronary artery bypass grafting (CABG; n=82, 12.67%, median door-to-needle time 1.74 days). Mean HEART scores were 5.86±1.7, and 6.91±1.59, respectively for these two groups (Fig 1). Conclusions: The length of hospital stay of NSTEACS patients before they underwent an invasive angiography was more than 3 days, even after excluding weekend admissions, and this prolongs hospital stay to nearly 6 days. Nearly one-third of these patients did not end up having PCI; thus, invasive angiography (and the delays related with it) could had been avoided if non-invasive diagnostic methods, such as coronary computed tomography (CT) angiography, were introduced on presentation, improving resource utilisation. |
|---|---|
| ISSN: | 1470-2118 |