Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: a national register-based cohort study
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 stud...
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crjcrbmj:10.1136/bmjopen-2023-081301 2024-03-24T09:01:53+00:00 Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: a national register-based cohort study Uleberg, Bård Bønaa, Kaare Harald Govatsmark, Ragna Elise Støre Olsen, Frank Jacobsen, Bjarne K Stensland, Eva Hauglann, Beate Vonen, Barthold Førde, Olav Helge Northern Norway Regional Health Authority UiT The Arctic University of Norway 2024 http://dx.doi.org/10.1136/bmjopen-2023-081301 https://syndication.highwire.org/content/doi/10.1136/bmjopen-2023-081301 en eng BMJ http://creativecommons.org/licenses/by-nc/4.0/ BMJ Open volume 14, issue 2, page e081301 ISSN 2044-6055 2044-6055 General Medicine journal-article 2024 crjcrbmj https://doi.org/10.1136/bmjopen-2023-081301 2024-02-26T15:37:38Z 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 30 min (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 ... Article in Journal/Newspaper Finnmark Finnmark The BMJ Norway BMJ Open 14 2 e081301 |
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The BMJ |
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crjcrbmj |
language |
English |
topic |
General Medicine |
spellingShingle |
General Medicine Uleberg, Bård Bønaa, Kaare Harald Govatsmark, Ragna Elise Støre Olsen, Frank Jacobsen, Bjarne K Stensland, Eva Hauglann, Beate Vonen, Barthold Førde, Olav Helge Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: a national register-based cohort study |
topic_facet |
General Medicine |
description |
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 30 min (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 ... |
author2 |
Northern Norway Regional Health Authority UiT The Arctic University of Norway |
format |
Article in Journal/Newspaper |
author |
Uleberg, Bård Bønaa, Kaare Harald Govatsmark, Ragna Elise Støre Olsen, Frank Jacobsen, Bjarne K Stensland, Eva Hauglann, Beate Vonen, Barthold Førde, Olav Helge |
author_facet |
Uleberg, Bård Bønaa, Kaare Harald Govatsmark, Ragna Elise Støre Olsen, Frank Jacobsen, Bjarne K Stensland, Eva Hauglann, Beate Vonen, Barthold Førde, Olav Helge |
author_sort |
Uleberg, Bård |
title |
Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: a national register-based cohort study |
title_short |
Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: a national register-based cohort study |
title_full |
Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: a national register-based cohort study |
title_fullStr |
Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: a national register-based cohort study |
title_full_unstemmed |
Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: a national register-based cohort study |
title_sort |
exploring variation in timely reperfusion treatment in st-segment elevation myocardial infarction in norway: a national register-based cohort study |
publisher |
BMJ |
publishDate |
2024 |
url |
http://dx.doi.org/10.1136/bmjopen-2023-081301 https://syndication.highwire.org/content/doi/10.1136/bmjopen-2023-081301 |
geographic |
Norway |
geographic_facet |
Norway |
genre |
Finnmark Finnmark |
genre_facet |
Finnmark Finnmark |
op_source |
BMJ Open volume 14, issue 2, page e081301 ISSN 2044-6055 2044-6055 |
op_rights |
http://creativecommons.org/licenses/by-nc/4.0/ |
op_doi |
https://doi.org/10.1136/bmjopen-2023-081301 |
container_title |
BMJ Open |
container_volume |
14 |
container_issue |
2 |
container_start_page |
e081301 |
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1794402089636462592 |