Do the outcomes of patients with non ST-elevation acute coronary syndromes differ if they are cared for in specialist or general settings?

Jones, ID

Abstract

This thesis explores whether there were differences in the characteristics and outcomes
of patients with non ST-elevation acute coronary syndromes admitted to specialist
cardiac units compared to those patients admitted to acute cardiology wards.
The study was undertaken using a secondary analysis of the PRAIS-UK dataset. This
dataset included a total of 1046 patients who were admitted to a range of hospital
settings with non ST-elevation acute coronary syndromes. This thesis reviews the data
of the 738 patients who were admitted to either the specialist cardiac units or cardiology
wards
The results showed that 84% of patients presented to hospital with a previous cardiac
history and the decision to allocate patients to care setting was frequently related to the
patient's presenting electrocardiogram, age and their previous cardiac history. However
a number of factors that have been linked to outcome were not taken into account when
considering care setting. Whilst in hospital the patients admitted to the specialist units
were more likely to suffer from severe angina and receive more evidence based therapy,
however the rate of mortality and myocardial infarction did not differ to a statistically
significant degree. In addition all differences between the two groups were eliminated
prior to, and following, discharge. A naturally occurring high risk group of patients
were then studied and the outcomes of this high risk group of patients cared for in the
specialist cardiac units did not differ to a statistically significant degree when compared
to those high risk patients cared for in acute cardiology wards.
«
An argument is made that there is no evidence to support the wholesale admission of
patients with non ST- elevation acute coronary syndromes to specialist cardiac units. It
is also argued that as most cardiac patients are cared for outside specialist units that
cardiac nursing education needs to encompass all nurses who regularly care for patients
with heart disease and more research is needed to evaluate the efficacy of costly models
of care regardless of their history.

Citation

Jones, I. Do the outcomes of patients with non ST-elevation acute coronary syndromes differ if they are cared for in specialist or general settings?. (Thesis). Salford : University of Salford

• Thesis Type: Thesis
• Deposit Date: Oct 3, 2012
• Award Date: Jan 1, 2006