Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: A national register-based cohort study
Permanent lenke
https://hdl.handle.net/10037/34430Dato
2024-02-17Type
Journal articleTidsskriftartikkel
Peer reviewed
Forfatter
Uleberg, Bård Erling; Bønaa, Kaare Harald; Govatsmark, Ragna Elise Støre; Olsen, Frank; Jacobsen, Bjarne K.; Stensland, Eva; Hauglann, Beate Kristin; Vonen, Barthold Gisle; Førde, Olav HelgeSammendrag
Objectives This study aimed to investigate determinants
of reperfusion within recommended time limits (timely
reperfusion) for ST-segment elevation myocardial
infarction patients, exploring the impact of geography,
patient characteristics and socio-economy.
Design National register-based cohort study.
Setting Multilevel logistic regression models were applied
to examine the associations between timely reperfusion
and residency in hospital referral areas and municipalities,
patient characteristics, and socio-economy.
Participants 7607 Norwegian ST-segment elevation
myocardial infarction patients registered in the
Norwegian Registry of Myocardial Infarction during
2015–2018.
Main outcome measures The odds of timely reperfusion
by primary percutaneous coronary intervention (PCI) or
fibrinolysis.
Results Among 7607 ST-segment elevation myocardial
infarction patients in Norway, 56% received timely
reperfusion. The Norwegian goal is 85%. While 81% of the
patients living in the Oslo hospital referral area received
timely reperfusion, only 13% of the patients living in
Finnmark did so.
Patients aged 75–84 years had lower odds of timely
reperfusion than patients below 55 years of age (OR
0.73, 95%CI 0.61 to 0.87). Patients with moderate or
high comorbidity had lower odds than patients without
(OR 0.81, 95%CI 0.68 to 0.95 and OR 0.61, 95%CI 0.44
to 0.84). More than 2 hours from symptom onset to first
medical contact gave lower odds than less than 30min
(OR 0.63, 95%CI 0.54 to 0.72). 1–2 hours of travel time to
a PCI centre (OR 0.39, 95%CI 0.31 to 0.49) and more than
2 hours (OR 0.22, 95%CI 0.16 to 0.30) gave substantially
lower odds than less than 1 hour of travel time.
Conclusions The varying proportion of patients
receiving timely reperfusion across hospital referral areas
implies inequity in fundamental healthcare services, not
compatible with established Norwegian health policy.
The importance of travel time to PCI centre points at the
expanded use of prehospital pharmacoinvasive strategy to
obtain the goals of timely reperfusion in Norway.
Forlag
BMJSitering
Uleberg, Bønaa, Govatsmark, Olsen, Jacobsen, Stensland, Hauglann, Vonen, Førde. Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: A national register-based cohort study. BMJ Open. 2024;14(2)Metadata
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