British Heart Journal最新文献

{"title":"Clinical outcomes in spontaneous coronary artery dissection","authors":"M. García-Guimarães, M. Masotti, R. Sanz-Ruiz, F. Macaya, G. Roura, J. Nogales, H. Tizón-Marcos, Maite Velázquez-Martín, G. Veiga, X. Flores-Ríos, Omar Abdul-Jawad Altisent, M. Jiménez-Kockar, S. Camacho-Freire, J. Moreu, S. Ojeda, S. Santos-Martínez, A. Sanz-García, D. del Val, T. Bastante, F. Alfonso","doi":"10.1136/heartjnl-2022-320830","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320830","url":null,"abstract":"Objective Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome. Our aim was to assess adverse events at follow-up from a nationwide prospective cohort. Methods The Spanish Registry on SCAD (SR-SCAD) included patients from 34 hospitals. All coronary angiograms were analysed by two experts. Those cases with doubts regarding the diagnosis of SCAD were excluded. The angiographic SCAD classification by Saw et al was followed. Major adverse cardiovascular and cerebrovascular event (MACCE) was predefined as composite of death, myocardial infarction, unplanned revascularisation, SCAD recurrence or stroke. All events were assigned by a Clinical Events Committee. Results After corelab evaluation, 389 patients were included. Most patients were women (88%); median age 53 years (IQR 47–60). Most patients presented as non-ST-segment-elevation myocardial infarction (54%). A type 2 intramural haematoma (IMH) was the most frequent angiographic pattern (61%). A conservative initial management was selected in 78% of patients. At a median time of follow-up of 29 months (IQR 17–38), 46 patients (13%) presented MACCE, mainly driven by reinfarctions (7.6%) and unplanned revascularisations (6.2%). Previous history of hypothyroidism (HR 3.79; p<0.001), proximal vessel involvement (HR 2.69; p=0.009), type 2 IMH (HR 2.12; p=0.037) and dual antiplatelet therapy (DAPT) at discharge (HR 2.18; p=0.042) were independent predictors of MACCE. Conclusions In this large prospective cohort of patients with SCAD, prognosis was overall favourable, with events mainly driven by reinfarctions or unplanned revascularisations. History of hypothyroidism, proximal vessel involvement, type 2 IMH and DAPT at discharge were associated with MACCE. Trial registration number NCT03607981.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1530 - 1538"},"PeriodicalIF":0.0,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44744108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting outcome after cardiac resynchronisation therapy defibrillator implantation: the cardiac resynchronisation therapy defibrillator Futility score","authors":"B. Maille, A. Bodin, A. Bisson, J. Herbert, B. Pierre, N. Clementy, Victor Klein, F. Franceschi, J. Deharo, L. Fauchier","doi":"10.1136/heartjnl-2021-320532","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320532","url":null,"abstract":"Background Risk-benefit for cardiac resynchronisation therapy (CRT) defibrillator (CRT-D) over CRT pacemaker remains a matter of debate. We aimed to identify patients with a poor outcome within 1 year of CRT-D implantation, and to develop a CRT-D Futility score. Methods Based on an administrative hospital-discharge database, all consecutive patients treated with prophylactic CRT-D implantation in France (2010–2019) were included. A prediction model was derived and validated for 1-year all-cause death after CRT-D implantation (considered as futility) by using split-sample validation. Results Among 23 029 patients (mean age 68±10 years; 4873 (21.2%) women), 7016 deaths were recorded (yearly incidence rate 7.2%), of which 1604 (22.8%) occurred within 1 year of CRT-D implantation. In the derivation cohort (n=11 514), the final logistic regression model included—as main predictors of futility—older age, diabetes, mitral regurgitation, aortic stenosis, history of hospitalisation with heart failure, history of pulmonary oedema, atrial fibrillation, renal disease, liver disease, undernutrition and anaemia. Area under the curve for the CRT-D Futility score was 0.716 (95% CI: 0.698 to 0.734) in the derivation cohort and 0.692 (0.673 to 0.710) in the validation cohort. The Hosmer-Lemeshow test had a p-value of 0.57 suggesting accurate calibration. The CRT-D Futility score outperformed the Goldenberg and EAARN scores for identifying futility. Based on the CRT-D Futility score, 15.9% of these patients were categorised at high risk (predicted futility of 16.6%). Conclusions The CRT-D Futility score, established from a large nationwide cohort of patients treated with CRT-D, may be a relevant tool for optimising healthcare decision-making.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1186 - 1193"},"PeriodicalIF":0.0,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49483931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Getting the best from the Heart Team: guidance for cardiac multidisciplinary meetings","authors":"A. Archbold, E. Akowuah, A. Banning, A. Baumbach, P. Braidley, G. Cooper, S. Kendall, P. MacCarthy, P. O'Kane, N. O'Keeffe, B. Shah, Victoria Watt, S. Ray","doi":"10.1136/heartjnl-2021-320510","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320510","url":null,"abstract":"The purpose of this document is to update the existing joint British Societies recommendations on multidisciplinary meetings (MDMs) published in 2015 to reflect changes in practice. We aim to provide guidance on the structure and function of MDMs which should be taking place in every cardiac surgical centre. Out of scope are MDMs that do not require the routine presence of a cardiac surgeon such as electrophysiology MDMs and those which are not provided in every centre, such as complex aortic surgery.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"e2 - e2"},"PeriodicalIF":0.0,"publicationDate":"2022-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42031890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"British Societies' recommendations for Heart Team multidisciplinary meetings: broadly relevant principles with anticipated regional differences in process","authors":"B. Lindman, K. Goel","doi":"10.1136/heartjnl-2021-320775","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320775","url":null,"abstract":"The concept of a Heart Team approach to evaluating patients with cardiovascular disease was fuelled by the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial for severe coronary artery disease and the Placement of Aortic Transcatheter Valves (PARTNER) trial for aortic stenosis (AS). 2 It was subsequently included as a recommended practice in guidelines for the management of patients with coronary artery disease and AS. Unpacking the rationale, purpose, composition, process and work of the Heart Team has been an evolving process that is being increasingly applied to additional cardiovascular diseases. Professor Ray and working group colleagues provide a consensus statement which outlines guidance from the British Societies regarding the multidisciplinary meetings of the Heart Team to address myocardial revascularisation; aortic, mitral and tricuspid valve disease; and endocarditis (figure 1).","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"824 - 826"},"PeriodicalIF":0.0,"publicationDate":"2022-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42803663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heartbeat: hypertension risk is higher when obesity onset occurs earlier in adult life","authors":"C. Otto","doi":"10.1136/heartjnl-2022-321152","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321152","url":null,"abstract":"The risk of hypertension is higher in adults with an increased body mass index but there is little data on whether weight gain at a younger age is more detrimental than weight gain later in life. In order to address the impact of age of onset of overweight on the subsequent risk of hypertension, Li and colleagues compared 4742 subjects with newonset overweight to 4742 age and sexmatched normal weight controls in an ongoing communitybased prospective cohort in China with a mean followup interval of 5 years. After multivariable adjustment, they observed a stepwise increase in risk of hypertension in younger adults (particularly those less than age 40 years) with no significantly increased risk for those with onset of overweight at age 60 years or older (figure 1). In an editorial, Wong comments on the strengths of this study—large sample size, serial measurements, robustness of the data—but also points out the limitations—mostly men (68%), a single occupational class (a mining company), hypertension diagnosis based on a single measurement and lack of outcome data. Wong concludes that ‘These data suggest that prevention efforts aimed at the reduction or delay of overweight and obesity in younger individuals, may significantly impact the onset of hypertension in later life. Whether such an intervention significantly impacts the onset of cardiovascular disease and its related adverse outcomes requires future study.’ In studies based on costs and healthcare delivery in the USA, mitral transcatheter edgetoedge repair (TEER) appears to be costeffective for patients with heart failure with reduced ejection fraction (HFrEF) and severe secondary mitral regurgitation. In this issue of Heart, Cohen and colleagues examined whether mitral TEER in HFrEF patients with severe secondary MR would be costeffective in the NHS healthcare system. Overall, TEER reduced the rate of heart failure hospitalisations and improved survival (figure 2), but costs of TEER were higher than guidelinerecommended medical therapy (GRMT). Even so, the incremental costeffectiveness ratio was","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"661 - 663"},"PeriodicalIF":0.0,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42697270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A strange heart","authors":"Marinha Silva, Vitor Hugo Pereira, Alexandra Sousa","doi":"10.1136/heartjnl-2021-320677","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320677","url":null,"abstract":"24 Coronel R, Casini S, Koopmann TT, et al. Right ventricular fibrosis and conduction delay in a patient with clinical signs of Brugada syndrome: a combined electrophysiological, genetic, histopathologic, and computational study. Circulation 2005;112:2769–77. 25 Blok M, Boukens BJ. Mechanisms of arrhythmias in the Brugada syndrome. Int J Mol Sci 2020;21:7051–20. 26 Hoogendijk MGet al. The Brugada ECG pattern a marker of channelopathy, structural heart disease, or neither? Toward a unifying mechanism of the Brugada syndrome. Circ. Arrhythmia Electrophysiol 2010;3:283–90. 27 Catalano O, Antonaci S, Moro G, et al. Magnetic resonance investigations in Brugada syndrome reveal unexpectedly high rate of structural abnormalities. Eur Heart J 2009;30:2241–8. 28 Nademanee K, Raju H, de Noronha SV, et al. Fibrosis, connexin43, and conduction abnormalities in the Brugada syndrome. J Am Coll Cardiol 2015;66:1976–86. 29 Andorin A, Behr ER, Denjoy I, et al. Impact of clinical and genetic findings on the management of young patients with Brugada syndrome. Heart Rhythm 2016;13:1274–82. 30 Michowitz Y, Milman A, SarquellaBrugada G, et al. Feverrelated arrhythmic events in the multicenter survey on arrhythmic events in Brugada syndrome. Heart Rhythm 2018;15:1394–401. 31 Chung FP, Raharjo SB, Lin YJ, et al. A novel method to enhance phenotype, epicardial functional substrates, and ventricular tachyarrhythmias in Brugada syndrome. Heart Rhythm 2017;14:508–17. 32 Ikeda T, Abe A, Yusu S, et al. The full stomach test as a novel diagnostic technique for identifying patients at risk of Brugada syndrome. J Cardiovasc Electrophysiol 2006;17:602–7. 33 Miyazaki T, Mitamura H, Miyoshi S, et al. Autonomic and antiarrhythmic drug modulation of ST segment elevation in patients with Brugada syndrome. J Am Coll Cardiol 1996;27:1061–70. 34 Jons C, Gollob MH. Brugada syndrome: Let’s talk about sex. Heart Rhythm 2018;15:1466–7. 35 Sacher F, Probst V, Maury P, et al. Outcome after implantation of a cardioverterdefibrillator in patients with Brugada syndrome: a multicenter studypart 2. Circulation 2013;128:1739–47. 36 Raju H, Papadakis M, Govindan M, et al. Low prevalence of risk markers in cases of sudden death due to Brugada syndrome relevance to risk stratification in Brugada syndrome. J Am Coll Cardiol 2011;57:2340–5. 37 Sroubek J, Probst V, Mazzanti A, et al. Programmed ventricular stimulation for risk stratification in the Brugada syndrome: a pooled analysis. Circulation 2016;133:622–30. 38 Honarbakhsh S, Providencia R, Lambiase PD. Risk stratification in Brugada syndrome: current status and emerging approaches. Arrhythm Electrophysiol Rev 2018;7:79. 39 Meregalli PG, Tan HL, Probst V, et al. Type of SCN5A mutation determines clinical severity and degree of conduction slowing in lossoffunction sodium channelopathies. Heart Rhythm 2009;6:341–8. 40 AlKhatib SMet al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"675 - 746"},"PeriodicalIF":0.0,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46921269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inherited and modifiable factors need to be identified in young patients with atrioventricular block","authors":"E. Roseboom, A. Maass","doi":"10.1136/heartjnl-2022-320841","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320841","url":null,"abstract":"Atrioventricular block (AVB) is among the leading diagnoses requiring pacemaker implantation. The incidence of this cardiac conduction disorder increases with age: from the UK Biobank, a community-dwelling cohort of approximately half a million participants, conduction disorders were far more present in those ≥65 years of age versus under the age of 55 (55/10.000 vs 11/10.000, respectively). 1 AVB is defined as delayed or interrupted impulse conduction and can be caused by anatomical or func-tional disorders of the conduction system. An extrinsic or physiological AVB can be secondary to increased parasympathetic tone, and is often self- limiting and does not require therapy. Intrinsic or pathological AVB is subdivided into suprahisian and infrahisian, the being predominantly benign and the requiring is referred The main is the conduction elder","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1167 - 1168"},"PeriodicalIF":0.0,"publicationDate":"2022-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41482631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult patients with congenital heart disease in the intensive care unit","authors":"K. P. Ramlakhan, M. van der Bie, C. D. den Uil, E. Dubois, J. Roos‐Hesselink","doi":"10.1136/heartjnl-2021-320676","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320676","url":null,"abstract":"Objective Current data on intensive care unit (ICU) admissions in patients with adult congenital heart disease (ACHD) are limited and focus on admissions after elective cardiac surgery. This study describes non-elective ICU admissions in patients with ACHD. Methods A retrospective matched cohort study was performed from January 2000 until December 2015 in a tertiary care centre ICU (there was no cardiac care unit). Primary outcomes were short-term (during hospital stay or <30 days after discharge) and long-term (>30 days after discharge until end of follow-up) mortality. Outcomes were compared with non-ACHD non-elective ICU admissions, matched 1:1 on age, sex and admission diagnosis. Results A total of 138 admissions in 104 patients with ACHD (65.9% male, median age 30 years) were included, during 8.6 years of follow-up. The majority had a moderate-to-severe heart defect. Arrhythmia was the most common admission diagnosis (44.2%), followed by haemorrhage (10.9%), heart failure (8.7%) and pulmonary disease (8.7%). Short-term mortality and total mortality were lower in the ACHD admissions than in the non-ACHD admissions (4.8% vs 16.3%, p=0.005 and 17.3% vs 28.9%, p=0.030), whereas long-term (12.5% vs 12.6%, p=0.700) did not differ. Severe CHD (HR 3.1, 95% CI 1.1 to 8.6) at baseline, and mechanical circulatory support device use (8.3, 1.4 to 47.4) and emergency intervention (0.2, 0.1 to 0.7) during the ICU stay were independently associated with mortality in the ACHD group. Conclusions Non-elective ICU admissions in patients with ACHD are most often for arrhythmia and in patients with moderate-to-severe CHD. Reassuringly, short-term and total mortality are lower compared with patients without ACHD, however, long-term mortality is higher than expected for patients with ACHD.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1452 - 1460"},"PeriodicalIF":0.0,"publicationDate":"2022-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48575933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correspondence on 'Outcomes of catecholamine and/or mechanical support in Takotsubo syndrome' by Terasaki et al","authors":"J. Madias","doi":"10.1136/heartjnl-2022-320924","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320924","url":null,"abstract":"To the Editor: I enjoyed reading the report by Terasaki et al, about the 6169 patients with takotsubo syndrome (TTS) from the nationwide Japanese registry (JROADDPC) of all cardiac and vascular diseases, representing claims data of 4 years of registered patients, commenting on the particulars of patients with severe TTS (18.6%), who by definition necessitated catecholamines and/or mechanical support and patients with mild TTS, and the factors associated with complications and mortality. The authors found that the patients with severe TTS were more often male and had higher 30day inhospital mortality, Charlson scores, comorbid pneumonia, sepsis and higher ambulance use than patients with mild TTS, while mortality was increased with age. It has been previously theorised that the prevalence of diabetes mellitus (DM) may be lower in patients with TTS than in the general population, although others disagree with this notion. The implicit significance of this is that DM may exert a ‘protective effect’ towards the emergence of TTS, and in addition an ameliorating influence during hospitalisation (ie, ‘diabetes paradox’). 6 The overall prevalence of DM in the present study of patients with TTS was 14.1%, and DM was not a predictor of the severity of TTS in the univariate analysis (p=0.53), or 30day inhospital mortality (p=0.96). Since the study is based on a sizeable registry of >6000 patients, and is representative of the entire nation of Japan, it provides an opportunity to compare the prevalence of DM in patients with TTS (ie, 14.1%) with the prevalence of DM in the general Japanese population, particularly for women in their 60s and 70s, and the prevalence of DM in patients, again particularly for women in their 60s and 70s, admitted with other cardiac and vascular pathologies captured by the nationwide Japanese registry (JROADDPC). Indeed, it would be contributory to compare in parallel the corresponding DM prevalence of hypertension in the present study (42%) with the prevalence of hypertension in the general Japanese population, and in the patients admitted with other cardiac and vascular pathologies in the JROADDPC, particularly for women in their 60s and 70s, since hypertension is considered to be as frequent in patients with TTS, as in the general population, or in patients with other cardiac and vascular pathologies.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"986 - 986"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47068186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unscheduled care pathways in patients with myocardial infarction in Scotland","authors":"P. Hodgins, Megan A. Mcminn, A. Shah, M. Reed, S. Mercer, B. Guthrie","doi":"10.1136/heartjnl-2021-320614","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320614","url":null,"abstract":"Objective Treatment of acute myocardial infarction (MI) requires rapid transfer of people with chest pain to hospital, however, unscheduled care pathways vary in their directness (the minimal number of contacts to hospital admission). The aim was to examine unscheduled care pathways and the associations with mortality in people admitted with MI. Methods Retrospective population study of all people admitted to Scottish hospitals with a diagnosis of MI between 1 January 2015 and 31 December 2017. Linked data for all National Health Service Scotland unscheduled care services (NHS24 telephone triage service, primary care out of hours, ambulance, emergency department (ED)) was used to define continuous unscheduled care pathways (pathways), which were categorised by initial contact, and whether they were ‘direct’ (had minimum number of contacts between first contact and admission). Analysis estimated ORs and 95% CIs in adjusted models in which all covariates were included. Results 26 325 people admitted with MI (63.1% men, 61.6% aged 65+ years), of whom 5.6% died from coronary heart disease within 28 days. For 47.0%, the first unscheduled care contact was ambulance, 23.3% attended ED directly and 18.7% called telephone triage. 92.1% of pathways were direct. Pathways starting with telephone triage were more likely to be indirect compared with other initial contacts (adjusted OR (aOR) 1.97, 95% CI 1.61 to 2.40). Compared to direct pathways, indirect pathways starting with telephone triage were associated with higher mortality (aOR 1.97, 95% CI 1.61 to 2.40) as were indirect pathways starting with another service (aOR 1.55, 95% CI 1.19 to 2.01), but not direct pathways starting with telephone triage (aOR 0.87, 95% CI 0.74 to 1.02). Conclusion Unscheduled care pathways leading to admission with MI in Scotland are usually direct, but those starting with telephone triage were more commonly indirect. Those indirect pathways were associated with higher mortality.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1129 - 1136"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45019372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}