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

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 STelevation 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.