ABSTRACT
Danish emergency departments (EDs) are undergoing a reorganisation in which the EDs are changed to serve as the single portal of entry for all acute patients. This survey-based study evaluates the entry to the Danish hospitals for acute cardiac patients. In 62% of the EDs there is not a cardiologist on call around the clock, thus compromising the availability of echocardiography and cardiac supervision. The handling of cardiac patients varies and the quality in the visitation and admission of these patients fluctuates. Pre-hospital findings should be used consequently to triage cardiac patients.
Subject(s)
Healthcare Disparities , Heart Diseases , Patient Admission/standards , Triage/standards , Acute Disease , Cardiology Service, Hospital/standards , Cardiology Service, Hospital/statistics & numerical data , Clinical Competence/standards , Denmark , Emergency Service, Hospital/standards , Emergency Service, Hospital/statistics & numerical data , Heart Diseases/diagnosis , Heart Diseases/therapy , Hospital Departments/standards , Hospital Departments/statistics & numerical data , Humans , Internal Medicine/standards , Internal Medicine/statistics & numerical data , Patient Admission/statistics & numerical data , Quality of Health Care , Surveys and QuestionnairesABSTRACT
BACKGROUND: The impact of adherence to the recommended duration of dual antiplatelet therapy after first generation drug-eluting stent implantation is difficult to assess in real-world settings and limited data are available. METHODS: We followed 4,154 patients treated with coronary drug-eluting stents in Western Denmark for 1 year and obtained data on redeemed clopidogrel prescriptions and major adverse cardiovascular events (MACE, i.e., cardiac death, myocardial infarction, or stent thrombosis) from medical databases. RESULTS: Discontinuation of clopidogrel within the first 3 months after stent implantation was associated with a significantly increased rate of MACE at 1-year follow-up (hazard ratio (HR) 2.06; 95% confidence interval (CI): 1.08-3.93). Discontinuation 3-6 months (HR 1.29; 95% CI: 0.70-2.41) and 6-12 months (HR 1.29; 95% CI: 0.54-3.07) after stent implantation were associated with smaller, not statistically significant, increases in MACE rates. Among patients who discontinued clopidogrel, MACE rates were highest within the first 2 months after discontinuation. CONCLUSIONS: Discontinuation of clopidogrel was associated with an increased rate of MACE among patients treated with drug-eluting stents. The increase was statistically significant within the first 3 months after drug-eluting stent implantation but not after 3 to 12 months.
