Trends in time to invasive examination and treatment from 2001 to 2009 in patients admitted first time with non-ST elevation myocardial infarction or unstable angina in Denmark

OBJECTIVE: To investigate trends in time to invasive examination and treatment for patient with first time diagnosis of non-ST elevation myocardial infarction (NSTEMI) and unstable angina during the period from 2001 to 2009 in Denmark. DESIGN: From 1 January 2001 to 31 December 2009 all first time hospitalisations with NSTEMI and unstable angina were identified in the National Patient Registry (n=65 909). Time from admission to initiation of coronary angiography (CAG), percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) was calculated. We described the development in invasive examination and treatment probability (CAG, PCI and CABG at 3, 7, 10, 30 and 60 days) for the years 2001–2009, taking the competing risk of death into account using Aalen–Johansen estimators and a Fine-Gray model. SETTING: Nationwide Danish cohort. RESULTS: The proportion of patients receiving a CAG and PCI increased substantially over time while the proportion receiving a CABG decreased for both NSTEMI and unstable angina. For both NSTEMI and unstable angina, a significant increase in invasive examination and treatment probability at 3 days for CAG and PCI were seen especially from 2007 through to 2009. For NSTEMI, the CAG examination probability at 3 days leaped from 20% in 2007 to 32% in 2008 and 39% in 2009, and for PCI the same was true with a leap in treatment probability from 19% to 28% from 2008 to 2009. CONCLUSIONS: In Denmark the use of CAG and PCI in treatment of NSTEMI and unstable angina has increased from 2001 to 2009, while the use of CABG has decreased. During the same period, there was a marked increase in invasive examination and treatment probability at 3 days, that is, more patients were treated faster which is in line with the political aim of reducing time to treatment

Dobbeltdiagnosepatienters møde med det psykiatriske behandlingssystem

In this article, we present 17 interviews with patients with a dual diagnosis (the coexistence of a substance use disorder and a psychiatric disorder). These patients uniformly describeexperiences of being rejected or treated as second rank patients by the psychiatric treatment system. Based on a content-analysis of the 17 interviews we identify three different answers to the question of why patients are being meet this way. Firstly, drug use is generally stigmatized by society at large – and hence also by psychiatric staff. Secondly, patients with a dual diagnosis is living up to the traditional role of patient, among other things because they continue to use. And thirdly, the concept of disease that psychiatry apply – that of sharply distinguished disease entities – complicates treatment of complex diseases, such as dual diagnosis. We end the article by presenting the wished of the patients with regard to the psychiatric treatment system: to be met as a person and to receive competent treatment for their problems, including the substance use.I denne artikel præsenterer vi en interviewundersøgelse med 17 dobbeltdiagnosepatienter (patienter der både har et misbrug og en anden psykiatrisk lidelse), der beskriver deres erfaringer med at blive afvist eller behandlet dårligt i mødet med det psykiatriske behandlingssystem. På baggrund af en indholdsanalyse af patienternes fortællinger har vi identificeret tre forskellige svar på, hvorfor patienterne bliver mødt på denne måde. For det første fordi stofmisbrug generelt i samfundet bliver omfattet af stigmatisering, og at det også gælder personalet på de psykiatriske afdelinger. For det andet fordi patienterne ikke lever op til rollen som rigtige patienter – bl.a. fordi de fortsætter med at misbruge, når de kommer i psykiatrisk behandling. Og for det tredje fordi psykiatrien arbejder med en forståelse af psykisk sygdom – som værende præcist afgrænsede sygdomsenheder – der vanskeliggør behandlingen af komplekse lidelser som dobbeltdiagnose. Som afsluttende perspektivering peger vi på de ønsker, som patienterne selv har til det psykiatriske behandlingssystem, nemlig at blive mødt som hele mennesker og at få behandlet deres problemer – inklusivt misbrug – professionelt af personalet

Impact of Gender, Co-Morbidity and Social Factors on Labour Market Affiliation after First Admission for Acute Coronary Syndrome:A Cohort Study of Danish Patients 2001–2009

BACKGROUND: Over the last decades survival after acute coronary syndrome (ACS) has improved, leading to an increasing number of patients returning to work, but little is known about factors that may influence their labour market affiliation. This study examines the impact of gender, co-morbidity and socio-economic position on subsequent labour market affiliation and transition between various social services in patients admitted for the first time with ACS. METHODS: From 2001 to 2009 all first-time hospitalisations for ACS were identified in the Danish National Patient Registry (n = 79,714). For this population, data on sick leave, unemployment and retirement were obtained from an administrative register covering all citizens. The 21,926 patients, aged 18-63 years, who had survived 30 days and were part of the workforce at the time of diagnosis were included in the analyses where subsequent transition between the above labour market states was examined using Kaplan-Meier estimates and Cox proportional hazards models. FINDINGS: A total of 37% of patients were in work 30 days after first ACS diagnosis, while 55% were on sick leave and 8% were unemployed. Seventy-nine per cent returned to work once during follow-up. This probability was highest among males, those below 50 years, living with a partner, the highest educated, with higher occupations, having specific events (NSTEMI, and percutaneous coronary intervention) and with no co-morbidity. During five years follow-up, 43% retired due to disability or voluntary early pension. Female gender, low education, basic occupation, co-morbidity and having a severer event (invasive procedures) and receiving sickness benefits or being unemployed 30 days after admission were associated with increased probability of early retirement. CONCLUSION: About half of patients with first-time ACS stay in or return to work shortly after the event. Women, the socially disadvantaged, those with presumed severer events and co-morbidity have lower rates of return

Percentage in work, on sick leave and unemployed among patients, aged 18–64 years, admitted first time with acute coronary syndrome, who were part of the workforce at time of diagnosis and survived 30 days thereafter, in relation to gender, co-morbidity and socio-economic factors.

*<p>Marked category versus first variable category.</p

The percentage and Hazard Ratio (HR) of disability or voluntary early pension after a mean follow-up of 4.1 years among patients, aged 18–64 years, admitted first time with acute coronary syndrome, who were part of the workforce at time of diagnosis and survived 30 days thereafter, in relation to gender, co-morbidity and socio-economic factors.

*<p>age underlying timescale.</p

Kaplan-Meier estimates for return to work after acute coronary syndrome by gender.

<p>Kaplan-Meier estimates for return to work after acute coronary syndrome by gender.</p

Kaplan-Meier estimates for early retirement after acute coronary syndrome by gender.

<p>Kaplan-Meier estimates for early retirement after acute coronary syndrome by gender.</p