The Erne Mobile Intensive Coronary Care Study

Mortality, survival and MICCU

Abstract

This paper deals with the analysis and interpretation of data relating to mortality and survival in the first year of operation of the Erne MICCU study in Co. Fermanagh.

Aims

We aimed to measure in-hospital mortality from AMI, on WHO criteria, identify factors influencing mortality and survival and assess the performance of the MICCU.

Methods

All first admissions of suspected AMI to the CCU from the Fermanagh District in 1983–1984. Some 297 patients were analysed. We recorded demographic data, previous history of heart disease and co-morbidity, status of the current attack, delay to CCU, treatment and outcome. In total, 28 variables grouped as (a) basic risk factors (18) and (b) clinical and treatment risk factors (10) were analysed.

Outcomes

In-hospital mortality and survival and performance of the MICCU.

Results

There were 329 admissions to the CCU of all types of which 297 (90.3%) were first admissions. Of the 297, 170 (57.2%) had AMI on WHO criteria and 42 (14.1%) were dead at discharge. Crude, 28-day, mortality and unadjusted survival were statistically significantly worse in the AMI group. The multi-factor mortality analysis identified 5 variables influencing death at discharge. In relation to multi-factor survival, the MPR Weibull model identified a set of 9 variables in which the treatment variables pre-dominated over basic risk factors. The MICCU delivered patients to hospital statistically significantly earlier (5 h on average) than other modes of transport, but did not prevent more deaths than the ordinary ambulance.

Conclusions

There was no evidence of a direct, statistically significant, beneficial MICCU effect in either of the multi-factor mortality or survival models. However, the performance of the MICCU, measured in terms of crude survival, resulted from an adverse case-mix, which, when controlled for, suggested a small MICCU benefit. The findings relate to the first year of operation of the Erne MICCU study and may improve in later years.

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Notes

  1. 1.

    Department of Social and Preventive Medicine, The Queen’s University of Belfast.

  2. 2.

    South West Area Hospital (SWAH), since 21 June 2012.

  3. 3.

    These data will form the basis of further communications.

  4. 4.

    Roles adopted in subsequent years by para-medics.

  5. 5.

    Logarithm to the base e: the transformation makes the distribution more symmetric.

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Acknowledgements

We thank the people of County Fermanagh for their co-operation throughout the period of the study. In particular, we thank Professor Mahen Varma, and Dr. John Williams, Consultant Physicians and the junior medical staff at the Erne Hospital: Dr. Andrew McCarthy, Dr. John Kirby, Dr. Enda Chadwick, Dr. Paula Toner and Dr. Theo Nugent. Drs. E. Turkington and B. McAleer were also very helpful in relation to data processing. Invaluable support and co-operation was provided by Jenny Cecil, Maizie Fleming and Sisters O’Kane and McNiff and their staffs at the Erne hospital. The MICCU vehicle was donated by Lisbellaw Young Farmers Club and incidental expenses were provided by local research funds. Dr. Turkington was supported by Action for Community Employment (Ace) funding through the Northern Ireland Chest Heart and Stroke Association and by the Western Health Trust. Finally, we thank the referees for their useful comments which improved the paper.

Funding

The study was supported by the Chest Heart and Stroke Association NI (Registered Charity), the Western Health and Social Services Board NI, via the Ace scheme, by the Lisbellaw Young Farmers Club and by Public donation.

Author information

Affiliations

Authors

Contributions

The paper was drafted by the second author. Subsequently, both authors worked to improve the draft. The first author contributed to the Introduction and Discussion while the second author conducted the statistical analysis. Both authors were involved in interpreting the findings and refining the paper.

Corresponding author

Correspondence to Gilbert MacKenzie.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethics approval

This study was conducted in accordance with the ethical standards of the NHS Western Health and Social Services Board and within the 1964 Helsinki Declaration and its later amendments. The study was approved by the REC of the Queen’s University University of Belfast in 1982.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article describes findings from the Erne Mobile Coronary Care Study conducted in Co. Fermanagh, Ireland, in 1983/1984. The study data were misfiled (in storage) and have only recently been recovered and re-analysed. Accordingly, this is the first paper to be published from this prospective study in the past.

Appendix. WHO Diagnostic Criteria for MI

Appendix. WHO Diagnostic Criteria for MI

A summary of the WHO Diagnostic Criteria for MI [12] follows:

  1. 1.

    Definite MI

  • Typical ECG

  • OR Equivocal ECG with definite enzymes

  • OR Typical History with definite enzymes

  • OR Positive post-mortem

  1. 2.

    Possible MI

  • Remaining surviving cases with typical history including history of pain (typical or not)

  • OR Fatal Cases with past history of chronic IHD

  • OR Post-mortem evidence of chronic IHD

  1. 3.

    Not MI

  • Remaining living cases notified

  • OR Fatal Cases where another diagnosis made

  1. 4.

    Insufficient Information

  • Remaining fatal cases notified

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Donnelly, M., MacKenzie, G. The Erne Mobile Intensive Coronary Care Study. Ir J Med Sci (2021). https://doi.org/10.1007/s11845-020-02498-8

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Keywords

  • Clinical epidemiology
  • CCU
  • MICCU
  • Mortality
  • Prospective study
  • Survival