This article has been peer reviewed and accepted for publication. It is in production and has not been edited, so may differ from the final published form.
Expertise and infrastructure capacity impacts acute coronary syndrome outcomes
Abstract Effective translation of evidence to practice may depend on systems of care characteristics within the health service. Associations between hospital expertise and infrastructure capacity and acute coronary syndrome(ACS) care as part of the SNAPSHOT ACS registry were evaluated. Methods and results A survey collected hospital-level data and scored hospital infrastructure and expertise capacity. Patient-level data from a registry of 4,387 suspected ACS patients were enrolled during 2-weeks and associations with guideline care and in-hospital, 6, 12 18-month outcomes were measured. Of 375 participating hospitals, 348 (92.8%) were included. Higher expertise was associated with increased coronary angiogram comparing low capacity: 440/1,329(33.1%) vs intermediate: 580/1,656 (35.0%) vs high: 609/1,402(43.4%), p < 0.001 and prescription of guideline therapies: low: 531/ 1,329(39.9%) vs intermediate: 733/1,656(44.3%) vs high: 603/1,402(43.0%), p = 0.056, but not for rehabilitation comparing low:474/1329 (35,7%) vs intermediate: 603/1656(36.4%) vs high: 535/1,402(38.2%, p=0.377). Higher expertise was associated with lower major adverse events; low: 152/1,329(11.4%) vs intermediate: 142/ 1,656(8.6%) vs high: 149/149(10.6%), p= 0.026 and adjusted mortality within 18-months; low versus intermediate: OR: 0.79 (95% CI: 0.58-1.08), p=0.153 and intermediate versus high OR:0.64(95% CI:0.48-0.86) p=0.003, Conclusions Both higher level expertise decision-making and infrastructure capacity are associated with improved evidence translation and survival within 18-months of an ACS event and has clear healthcare design and policy implications.
AH16244 Accepted 24 February 2017
© CSIRO 2017