IJE Advance Access originally published online on March 31, 2005
International Journal of Epidemiology 2005 34(2):422-430; doi:10.1093/ije/dyh377
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Pre-hospital coronary care and coronary fatality in the Belfast and Glasgow MONICA populations
1 Department of Epidemiology and Public Health, Queen's University of Belfast, Belfast, Northern Ireland, UK
2 Greater Glasgow Health Board, Dalian House, PO Box 15329, 350 St Vincent Street, Glasgow G3 8YZ, Scotland, UK
3 Cardiovascular Epidemiology Unit, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland DD1 9SY, UK
* Corresponding author. Department of Epidemiology and Public Health, Queen's University of Belfast, Mulhouse Building, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, UK. E-mail: f.kee{at}qub.ac.uk
Background The aim of this study was to describe and compare coronary event case fatality and care pathways in two defined populations with access to different models of pre-hospital care provision.
Methods Secondary analysis of MONItoring of Trends and Determinants in CArdiovascular Disease (MONICA) population coronary event registers (1988, 1989, 1990, 1992 and 1993).
Results Case fatality at 28 days following an acute coronary event was 6.5% greater in the Glasgow MONICA Project (GMP) population (46.7%) than in the Belfast MONICA Project (BMP) population (40.2%). Pre-hospital case fatality was 33.9% in the GMP population and 28.3% in the BMP population. These differences could not be fully explained by mobile coronary care unit (MCCU) responses in the BMP area. Initial care was provided in hospital for 28.3% of the BMP events and only 7.7% of the GMP events. Additional data collected by the Belfast and Glasgow MONICA investigators support a large difference between the median delay to main medical care in the BMP events (120 min) and the median delay to ward admission in the GMP area (220 min) at this time.
Conclusions Our findings suggest that the delay between coronary event onset and access to specialist coronary care was the most likely critical difference, irrespective of hospital-based MCCU provision in the BMP area. An established ‘culture of early intervention’ in Belfast may have been an important factor. As a large proportion of coronary event fatalities continue to occur outside hospital, there is a need to strengthen the evidence base underpinning the provision of appropriate skilled care and treatment at the earliest possible opportunity.
Keywords MONICA, coronary event register, mortality, coronary heart disease, myocardial infarction, pre-hospital care
Accepted 13 October 2004
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