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Regional variations in hospital management and post-discharge mortality in patients with non-ST-segment elevation acute coronary syndrome

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Abstract

Background

Therapeutic variability not explained by patient clinical characteristics is a potential source of avoidable morbidity and mortality. We aimed to explore regional variability in the management and mortality of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS).

Methods and results

11,931 NSTE-ACS hospital survivors enrolled in two prospective registries: EPICOR [5625 patients, 555 hospitals, 20 countries in Europe (E) and Latin America (LA), September 2010–March 2011] and EPICOR Asia (6306 patients, 218 hospitals, 8 countries, June 2011–May 2012) were compared among eight pre-defined regions: Northern E (NE), Southern E (SE), Eastern E (EE); Latin America (LA); China (CN), India (IN), South-East Asia (SA), and South Korea, Hong Kong and Singapore (KS). Patient characteristics differed between regions: mean age (lowest 59 years, IN; highest 65.9 years, SE), diabetes (21.4% NE; 35.5% IN) and smoking (32% NE; 62% IN). Variations in dual antiplatelet therapy at discharge (lowest 83.1%, IN; highest 97.5%, SA), coronary angiography (53.9% SA; 90.6% KS), percutaneous coronary intervention (35.8% SA; 78.6% KS) and coronary artery bypass graft (0.7% KS; 5.7% NE) were observed. Unadjusted 2-year mortality ranged between 3.8% in KS and 11.7% in SE. Two-year, risk-adjusted mortality rates ranged between 5.1% (95% confidence interval 2.9–7.3%) in KS to 10.5% (8.3–12.7%) in LA.

Conclusion

Wide regional variations in patient features, hospital care, coronary revascularization and post-discharge mortality are present among patients hospitalized for NSTE-ACS. Focused regional interventions to improve the quality of care for NSTE-ACS patients are still needed.

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Acknowledgements

Editorial support was provided by Carl V Felton PhD of Prime (Knutsford, Cheshire, UK), supported by AstraZeneca. Ultimate responsibility for opinions, conclusions, and data interpretation lies with the author. X.R. has received support from the SEC-CNIC CARDIOJOVEN fellowship program.

Funding

EPICOR and EPICOR Asia are funded by AstraZeneca. Being a non-interventional study, no drugs were supplied or funded.

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Authors and Affiliations

  1. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernandez Almagro, 3, 28029, Madrid, Spain

    Héctor Bueno & Xavier Rossello

  2. Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain

    Héctor Bueno

  3. Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain

    Héctor Bueno

  4. London School of Hygiene and Tropical Medicine, London, UK

    Xavier Rossello & Stuart Pocock

  5. CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain

    Xavier Rossello

  6. Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium

    Frans Van de Werf

  7. National Heart Centre Singapore, Singapore, Singapore

    Chee Tang Chin

  8. Hôpital Européen Georges Pompidou and René Descartes University, Paris, France

    Nicolas Danchin

  9. Queen Mary Hospital, Hong Kong SAR, China

    Stephen W-L Lee

  10. Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Madrid, Spain

    Jesús Medina & Ana Vega

  11. Beijing University First Hospital, Beijing, China

    Yong Huo

Authors
  1. Héctor Bueno
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  2. Xavier Rossello
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  3. Stuart Pocock
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  4. Frans Van de Werf
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  5. Chee Tang Chin
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  6. Nicolas Danchin
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  7. Stephen W-L Lee
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  8. Jesús Medina
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  9. Ana Vega
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  10. Yong Huo
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Corresponding author

Correspondence to Héctor Bueno.

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Conflict of interest

H.B. has received consulting fees from Abbott, AstraZeneca, Bayer, BMS, Novartis and Pfizer; speaking fees from AstraZeneca, Bayer, BMS-Pfizer, Ferrer, Novartis, Servier and MEDSCAPE-the heart.org; and fees for research activities from AstraZeneca, BMS, Janssen, Novartis; S.P. has received research funding from AstraZeneca. F.v.d.W. has received consulting fees and research grants from Boehringer Ingelheim and Merck, and consulting fees from Roche, Sanofi-Aventis, AstraZeneca, and The Medicines Company. C.T.C. has received research support from Eli Lilly, honoraria from Medtronic, and has been a consultant or advisory board member for AstraZeneca. N.D. has received consulting or speaking fees from AstraZeneca, BMS, Boehringer-Ingelheim, GSK, MSD-Schering Plough, Novartis, Pierre Fabre, Pfizer, Roche, Sanofi-Aventis, Servier, Takeda, and The Medicines Company. J.M. and A.V. are employees of AstraZeneca. X.R., S.W-L.L. and Y.H. have nothing to disclose.

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Bueno, H., Rossello, X., Pocock, S. et al. Regional variations in hospital management and post-discharge mortality in patients with non-ST-segment elevation acute coronary syndrome. Clin Res Cardiol 107, 836–844 (2018). https://doi.org/10.1007/s00392-018-1254-y

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  • DOI: https://doi.org/10.1007/s00392-018-1254-y

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