Trend In Acute Coronary Syndrome IV (<45y)
Lessons from an undisclosed UK NHS Trust
In my previous post in this series on #ACS we pondered on the Jan – Mar hump in cases aged 45 years and over and seeming lack of overall trend for those under 45y. I’d been using the ECDS dataset for a substantial NHS Trust for this analysis and into the pot I had thrown the following diagnoses on admission:
Acute coronary syndrome
Acute non-ST segment elevation myocardial infarction
Acute ST segment elevation myocardial infarction
Cardiac arrest
Cardiogenic shock
Long QT syndrome
Preinfarction syndrome
Despite this the data appeared to be at odds with reports of cardiac issues among younger folk from healthcare professionals and reports popping up in MSM.
It is worth noting that ECDS is the brand new bells and whistles system used by emergency departments in the UK that kicked off in Jan 2021. Suspecting another of those we-seem-to-have-lost-folk coding issues I decided to flip back to the old CDS registration system to see what could be seen. This doesn’t offer the same diagnostic resolution, there being just three codes to cover all of cardiac :
Cardiac conditions
Cardiac conditions - myocardial ischaemia & infarction
Cardiac conditions - other non-ischaemia
I decided to stick them all in the pot and run the data series back to Jan 2017 and this is what I found...
In the first slide there is a pronounced peak of 3.2% of all admissions under 45y that occurred during week 4 (w/b 23rd Jan) but if we place our thumb over this nothing else sticks out and the series appears to follow historic patterns. A non-parametric test of randomness (runs test) reminds us that this is not a random walk and that there is an underlying pattern in cardiac cases (p<0.001).
This pattern doesn’t look seasonal as such but something interesting is most certainly going on, including a flurry between 2020 week 14 and week 22. The great difficulty here is ascertaining whether this wave function is a disease-led trend happening out in the population or whether it’s a trend generated by administration (bed availability, medics on call, bank nursing supply etc).
In the second slide for those aged 45 years and older we see a different wave pattern for cardiac admissions. Note the greater values along the vertical axis – we’re now up at 10% of all A&E admissions. Week 12 of 2017 stands out like a sore thumb at 13.3%, this being w/b 18th Mar. The slide downward from spring to summer is most curious as is what appears to be a non-seasonal ebb and flow to cardiac cases. I am hoping some of our clinicians will shed some light on this curiosity, meanwhile I’ll get the kettle on and I’ll have another swipe at this puzzle…
