Chain of care in chest pain - Differences between three hospitals in an urban area

AimTo describe differences in treatment and delay times in acute chest pain at the three hospitals in Göteborg, Sweden.MethodsAll patients admitted to the three hospitals within Sahlgrenska University (SU) (Sahlgrenska: SU/S, Östra: SU/Ö and Mölndal: SU/M) with acute chest pain during 3 months in 2008 were evaluated for diagnosis, early treatment and outcome.ResultsIn all, 2588 visits by 2393 patients were included (visits n = 1253 SU/S; n = 853 SU/Ö; n = 482 SU/M) of which 50%, 63% and 51% were hospitalised (p < 0.0001). Among hospitalised patients, a diagnosis of ACS was reported in 26%, 9% and 22% respectively (p < 0.0001). Among ACS patients, 83%, 66% and 57% respectively underwent coronary angiography (p = 0.004).The median delay to coronary angiography in ST-elevation myocardial infarction (STEMI) was 42 min at SU/S, 3 h 47 min at SU/Ö and 2 h 34 min at SU/M (p = 0.008). The corresponding values for coronary angiography in unstable coronary artery disease were 42 h 7 min, 48 h 35 min and 123 h 42 min (p = 0.007). Overall mortality at 30 days was 3.6%, 3.2% and 1.5% (NS) and, at 1 year, it was 9.9%, 9.6% and 7.3% respectively (NS).ConclusionIn acute chest pain in the Municipality of Göteborg, there was a marked difference between hospitals in: 1) the percentage of hospitalised patients, 2) the percentage of ACS among hospitalised patients and 3) the delay to and rate of coronary angiography. The clinical consequences of these deviations remain to be proven.