Emergency admissions for coronary heart disease: a cross-sectional study of general practice, population and hospital factors in England

Objectives: Coronary heart disease (CHD) is a common reason for emergency admission in England. The objective of this study was to determine the association between general practice, population and hospital characteristics, including quality and outcomes framework (QOF) scores, with emergency admissions for angina, which is an ambulatory-care-sensitive condition, and myocardial infarction (MI).

Study design: Cross-sectional study using hospital episode statistics, population and primary care data.

Methods: Pooled admissions (2005/2006) for all general practices in England adjusted for age and gender. Main outcome measures were relative rates of admission [incidence rate ratio (IRR)] for general practices adjusted for confounding variables in a multiple regression Poisson model.

Results: There were 80,377 admissions for angina and 62,373 admissions for MI for individuals aged ≥45 years. Characteristics positively associated with admission were deprivation [angina IRR 1.084 (95% confidence interval 1.052-1.117) per quartile increase, MI IRR 1.018 (95% confidence interval 1.009-1.028)], practice prevalence of CHD and smoking. Living in an urban area and closer to the emergency department increased the risk of admission for angina. Higher overall clinical QOF score was negatively associated with the risk of admission for angina. Training practices and higher numbers of general practitioners per registered population were associated with lower rates of MI admission. Practice size and condition-specific quality markers for CHD were not associated with the risk of admission.

Conclusions: There is no clinically significant relationship between better quality of primary care, as measured by disease-specific QOF measures, and fewer CHD admissions. Deprivation, CHD prevalence and smoking are major risk factors for emergency admission for CHD.