{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T13:00:24Z","timestamp":1788267624359,"version":"build-2803163510"},"reference-count":53,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,5,20]]},"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate geographic variation in guideline-indicated treatments for non-ST-elevation myocardial infarction (NSTEMI) in the English National Health Service (NHS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cohort study using registry data from the Myocardial Ischaemia National Audit Project.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>All Clinical Commissioning Groups (CCGs) (n=211) in the English NHS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>357\u2005228 patients with NSTEMI between 1 January 2003 and 30 June 2013.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measure<\/jats:title>\n                    <jats:p>Proportion of eligible NSTEMI who received all eligible guideline-indicated treatments (optimal care) according to the date of guideline publication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The proportion of NSTEMI who received optimal care was low (48\u2005257\/357\u2005228; 13.5%) and varied between CCGs (median 12.8%, IQR 0.7\u201318.1%). The greatest geographic variation was for aldosterone antagonists (16.7%, 0.0\u201340.0%) and least for use of an ECG (96.7%, 92.5\u201398.7%). The highest rates of care were for acute aspirin (median 92.8%, IQR 88.6\u201397.1%), and aspirin (90.1%, 85.1\u201393.3%) and statins (86.4%, 82.3\u201391.2%) at hospital discharge. The lowest rates were for smoking cessation advice (median 11.6%, IQR 8.7\u201316.6%), dietary advice (32.4%, 23.9\u201341.7%) and the prescription of P2Y\n                      <jats:sub>12<\/jats:sub>\n                      inhibitors (39.7%, 32.4\u201346.9%). After adjustment for case mix, nearly all (99.6%) of the variation was due to between-hospital differences (median 64.7%, IQR 57.4\u201370.0%; between-hospital variance: 1.92, 95% CI 1.51 to 2.44; interclass correlation 0.996, 95% CI 0.976 to 0.999).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Across the English NHS, the optimal use of guideline-indicated treatments for NSTEMI was low. Variation in the use of specific treatments for NSTEMI was mostly explained by between-hospital differences in care. Performance-based commissioning may increase the use of NSTEMI treatments and, therefore, reduce premature cardiovascular deaths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>NCT02436187.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-011600","type":"journal-article","created":{"date-parts":[[2016,7,12]],"date-time":"2016-07-12T22:04:14Z","timestamp":1468361054000},"page":"e011600","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":23,"title":["Geographic variation in the treatment of non-ST-segment myocardial infarction in the English National Health Service: a cohort study"],"prefix":"10.1136","volume":"6","author":[{"given":"T B","family":"Dondo","sequence":"first","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Hall","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A D","family":"Timmis","sequence":"additional","affiliation":[{"name":"The National Institute for Health Biomedical Research Unit, Barts Health, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A T","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P D","family":"Batin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Oliver","sequence":"additional","affiliation":[{"name":"National Health Service cardiac service user, West Yorkshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O A","family":"Alabas","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Norman","sequence":"additional","affiliation":[{"name":"School of Geography, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J E","family":"Deanfield","sequence":"additional","affiliation":[{"name":"National Institute for Cardiovascular Outcomes Research, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Bloor","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of York, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Hemingway","sequence":"additional","affiliation":[{"name":"The Farr Institute, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C P","family":"Gale","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK"},{"name":"York Teaching Hospital NHS Foundation Trust, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,7,12]]},"reference":[{"key":"2025121513305226000_6.7.e011600.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62070-X"},{"key":"2025121513305226000_6.7.e011600.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h3913"},{"key":"2025121513305226000_6.7.e011600.3","unstructured":"National Institute for Health and Care Excellence. 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