Survival Advantages for Myocardial Infarction: Hospitals and Therapies

"Admission to a hospital with capability for cardiac procedures is associated with a higher likelihood of referral for a cardiac procedure but not with a better short term clinical outcome."

This is the conclusion of a study conducted by Krumholz H. et al from Yale University School of Medicine, as part of the Cooperative Cardiovascular Project pilot in Connecticut, including 2521 patients with acute myocardial infarction, covered by Medicare from 1992 to 1993. The authors verified that cardiac catheterization was higher in the hospital with facilities, but the revascularization rate was similar during the initial episode of care and at 3 years. Mortality rate were similar for patients admitted to the 2 types of hospital at 30 days and at 3 years (Admission to hospitals with on site cardiac catheterization facilities: impact on long term and outcomes, Circulation 1998: November 10; 98 (19): 2010-6).

In another study realized by Krumholz H. et al, using data from the Cooperative Cardiovascular Project on 149.177 elderly Medicare patients with acute myocardial infarction in 1994 and 1995, they examined the care and outcomes of that patients admitted to 3 types of hospitals, those ranked high in cardiology (top ranked hospitals), hospitals not in the top rank that had on-site facilities for cardiac catheterization, coronary angioplasty and bypass surgery (similarly equipped hospitals) and the remaining hospitals. They compared 30 days mortality, the rate of use of aspirin, beta blockers, and reperfusion; and the relation of differences in rates of therapy to short-term mortality. Their conclusion was that admission to a hospital ranked high on the list of "America’s Best Hospitals" was associated with lower 30 days mortality and that a substantial portion of the survival advantage may be associated with these hospitals higher rate of use of aspirin and beta blocker therapy (Do "America’s Best Hospitals" Perform Better for Acute Myocardial Infarction?, The New England Journal of Medicine 1999: January 28; Volume 340, Number 4)

Comments:- What is interesting to note is that survival advantages  were not related to the quality level of hospitals or revascularization procedures rate, but with the higher rate of clinical therapies applied as stressed by the authors.  

Related pages :

Myogenic Theory of Myocardial Infarction (Announcement, historical review, interview and abstracts)

[ HEARTNEWS ]