Skip to main content
SpringerLink
Log in

The Erne Mobile Intensive Coronary Care Study

Mortality, survival and MICCU

  • Original Article
  • Published:
Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Notes

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

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

  3. These data will form the basis of further communications.

  4. Roles adopted in subsequent years by para-medics.

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

References

  1. Pedoe HT (l982) Report on the cardiovascular epidemiological unit: Initial programme, l982 onwards. Internal Report, Ninewells Hospital and Medical School Dundee

  2. Scarborough P, Wickramasinghe K, Bhatnagar P, Rayner M (2011) Trends in coronary heart disease: 1961-2011. British Heart Foundation, London

    Google Scholar 

  3. Uemura K, Pisa Z (1985) . World Health Statistics Quarterly 38:142–162

    CAS  Google Scholar 

  4. Greig M, Pemberton J, Hay I, MacKenzie G (1980) A prospective study of the development of CHD in a group of l202 middle-aged men. J Epidemiol Commun Health 34(1):23–30

    Article  CAS  Google Scholar 

  5. Evans AE, et al. (l983) MONICA PROJECT:Belfast Monica Project Manual of operations, The Department of Community Medicine, The Queen’s University of Belfast, Mulhouse Annexe, Royal Victoria Hospital Site, Belfast, Northern Ireland

  6. Yarnell J (1998) The PRIME study: classical risk factors do not explain the several fold differences in risk of coronary heart disease between France and Northern Ireland. Prospective Epidemiological Study of Myocardial Infarction. Quart J Med 91(10):667–76

    Article  CAS  Google Scholar 

  7. MacKenzie G, et al. (2017) Competing risk analysis of factors related to long-term incidence of CHD. J Epidemiol Community Health 71:33–36. https://doi.org/10.1136/jech-2016-207347

    Article  PubMed  Google Scholar 

  8. Pooling Project Research Group (1978) Final report of the Pooling Project. J Chron Dis 31:201–306

    Article  Google Scholar 

  9. Pantridge JF, Geddes JS (1967) A mobile intensive care unit in the management of myocardial infarction. Lancet 2:271–273

    Article  CAS  Google Scholar 

  10. Beaglehole R (1986) Medical management and the decline in mortality from coronary heart disease. B Med J Vol 292:33

    Article  CAS  Google Scholar 

  11. Julian DG (2001) The evolution of the coronary care unit. Cardiov Res 51:621–624

    Article  CAS  Google Scholar 

  12. McIlwaine W, Donnelly MD, Chivers AT, Evans AE, Elwood JH (1985) Certification of death from ischaemic heart disease in Belfast. Int J Epidemiol 14(4):560–565. https://doi.org/10.1093/ije/14.4.560

    Article  CAS  PubMed  Google Scholar 

  13. WHO Special Report (1979) Nomenclature and criteria for diagnosis of ischemic heart disease. Circulation 59(3):607–609

    Article  Google Scholar 

  14. Office of Population Censuses and Surveys (1970) Classifivation of Occupations, London, HMSO. NTC 5/1/157

  15. McIlwaine W, Donnelly MD, Mallaghan M, Chivers AT, Evans AE, Elwood JH, Adgey AJ, Campbell NP, Geddes JS (1986) Deaths from ischaemic heart disease in Belfast. Br Heart J 55 (4):330–335. https://doi.org/10.1136/hrt.55.4.330

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Cox DR (1970) The analysis of binary data. Methuen, London

    Google Scholar 

  17. IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, N.Y.), USA

  18. Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Amer Statist Assoc 53(282):457–481. https://doi.org/10.2307/2281868

    Article  Google Scholar 

  19. Cox DR (1972) Regression models and life tables (with Discussion). J R Statist Soc B 34:187–220

    Google Scholar 

  20. Peng D, MacKenzie G (2014) Discrepancy and choice of reference subclass in categorical regression models. In: MacKenzie G, Peng D (eds) Statistical modelling in biostatistics and bioimformatics. Springer, Munich

  21. Burke K, MacKenzie G (2017) Multi-parameter regression survival modelling - an alternative to proportional hazards. Biometrics 73:361–716

    Article  Google Scholar 

  22. R Core Team (2018) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

    Google Scholar 

  23. Burke K (2016) mpr: multi-parameter regression (MPR), R package version 1.0.2 (cran.r-project.org/package=mpr)

  24. Cunnane D, Varma MPS (2012) Heartbus in Enniskillen. Chest Heart and Stroke Association of NI Newsletter 1:1–2

    Google Scholar 

  25. Connolly S (2019) Positive health outcomes for Trust’s ’Our Hearts Our Minds’. Health News, Derrydaily.net(Sept)

  26. Song C, Fu R, Dou K et al (2019) Association between smoking and in- hospital mortality in patients with acute myocardial infarction: results from a prospective, multicentre, observational study in China. BMJ Open 9:1–7. https://doi.org/10.1136/bmjopen-2019-030252

    Article  Google Scholar 

  27. Gearty GF, Hickey N, Bourke GJ, Mulcahy R (1971) Pre-hospital coronary care service. British Med J 3:33–35

    Article  CAS  Google Scholar 

  28. Mulcahy R, Hickey N, Graham I, McKenzie G (1975) Factors influencing long-term prognosis in male patients surviving a first coronary attack. British Heart J 37:158–i65

    Article  CAS  Google Scholar 

  29. McIlwaine W, Chivers AT, Donnelly MD, Evans AE, MacKenzie G (1988) Fatal ischaemic heart disease in Belfast: a comparison of two community surveys. Ulster Med J 57(1):70–75

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Mathewson ZM, McCLoskey RG, Evans AE, et al. (1985) Mobile coronary care and community mortality from myocardial infarction. The Lancet, 441–444

  31. Dickey W, MacKenzie G, Adgey AJ (1991) Long-term survival after resuscitation from ventricular fibrillation occurring before hospital admission. Quart J Med 80(3):729–737. https://doi.org/10.1093

    CAS  PubMed  Google Scholar 

  32. Kirchberger I, Hunger M, Stollenwelk B, Seidl H, Burkhardt K, Kuch B, Meisinger C, Holle Rolf (2010) Effects of a 3 year nurse-based case management in aged patients with acute myocardial infarction on rehospitalisation, mortality, risk factors, physical functioning and mental health. A secondary analysis of randomised controlled KORINNA study. BMC Geriatr 10(3):1–17. https://doi.org/10.1371/journal.pone.0116693. e0116693

    Article  CAS  Google Scholar 

  33. Kush KK, Rapaport F, Waters D (2008) The history of the coronary care unit. Can J Cardiol 21(12):1041–1045

    Google Scholar 

  34. Dégano IR, Veikko S, Veronesi G et al (2015) Twenty-five-year trends in myocardial infarctionattack and mortality rates, and case-fatality. Six Eur Popul Heart 101(17):1413–1421

    Google Scholar 

Download references

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

Authors and Affiliations

  1. Bishop Auckland, Durham, DL13, UK

    Michael Donnelly

  2. Centre of Biostatistics, University of Limerick, Limerick, Ireland

    Gilbert MacKenzie

Authors
  1. Michael Donnelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gilbert MacKenzie
    View author publications

    You can also search for this author in PubMed Google Scholar

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Donnelly, M., MacKenzie, G. The Erne Mobile Intensive Coronary Care Study. Ir J Med Sci 191, 175–185 (2022). https://doi.org/10.1007/s11845-020-02498-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-020-02498-8

Keywords

Search

Navigation