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Influence of distance from home to invasive centre on invasive treatment after acute coronary syndrome: a nationwide study of 24 910 patients.
MedLine Citation:
PMID:  21051459     Owner:  NLM     Status:  In-Data-Review    
Objective To investigate whether distance from a patient's home to the nearest invasive centre influenced the invasive treatment strategy in acute coronary syndrome (ACS). Methods This was an observational cohort study using nationwide registries involving 24 910 patients admitted with ACS (median age 67, range 30-90&emsp14;years). All persons were grouped in tertiles according to the distance from their residence to the invasive centre. Cox proportional hazard models were applied to estimate the differences in coronary angiography and revascularisation rate within 60&emsp14;days of admission according to the distance to the centre. The end points were coronary angiography and subsequent revascularisation. Results Of 24 910 patients with a first ACS, 33% resided <21&emsp14;km from one of the five invasive centres in Denmark, 33% lived between 21 and 64&emsp14;km away and 34% lived >64&emsp14;km away. The incidence of coronary angiography was 68% for long distance versus 77% for short distance (p<0.05), with an HR of 0.78 (95% CI 0.75 to 0.81, p<0.0001). Adjustment for patient characteristics such as age, sex, co-morbidity and socioeconomic status did not attenuate the difference (HR 0.74, 95% CI 0.71 to 0.77, p<0.0001). Furthermore, revascularisation in the subgroup examined with coronary angiography was less likely for those residing a long distance from the invasive centre compared with those living nearer (adjusted HR of 0.82 (95% CI 0.78 to 0.85, p<0.0001). Conclusions In patients hospitalised with ACS, invasive examination and treatment were less likely the further away from an invasive centre the patients resided, thus equal and uniform invasive examination and treatment was not found.
Anders Hvelplund; Søren Galatius; Mette Madsen; Jeppe Nørgaard Rasmussen; Rikke Sørensen; Emil Loldrup Fosbøl; Jan Kyst Madsen; Søren Rasmussen; Erik Jørgensen; Leif Thuesen; Christian Holflod Møller; Steen Zabell Abildstrøm
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Publication Detail:
Type:  Journal Article     Date:  2010-11-04
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  97     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  27-32     Citation Subset:  AIM; IM    
National Institute of Public Health, Øster Farimagsgade 5A, DK1399, Copenhagen K, Denmark;
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