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Quality of care for myocardial infarction at academic and nonacademic hospitals

Loic Belle1, José Labarère, Magali Fourny

  • 1Department of Cardiology, Annecy General Hospital, France.

The American Journal of Medicine
|March 27, 2012
PubMed

Insights

Academic hospitals offer better care for ST-segment elevation myocardial infarction patients, improving survival through recommended therapies. This study compared care quality and mortality rates between academic and nonacademic hospitals.

Area of Science:

  • Cardiology
  • Health Services Research

Background:

  • Debate exists on whether academic hospitals provide superior care for acute myocardial infarction (AMI).
  • This study aimed to compare care processes and mortality between academic and nonacademic hospitals in the current AMI management era.

Purpose of the Study:

  • To compare processes of care and mortality for acute myocardial infarction (AMI) patients treated at academic versus nonacademic hospitals.
  • To assess the impact of hospital type and percutaneous coronary intervention (PCI) capability on patient outcomes.

Main Methods:

  • Analysis of prospective cohort data from 3059 AMI patients (1714 ST-elevation MI, 1345 non-ST-elevation MI).
  • Patients were enrolled across 39 academic and 183 nonacademic hospitals in France.
  • Comparison of unadjusted and adjusted 1-year mortality rates, focusing on receipt of reperfusion and recommended drug therapies.

Main Results:

  • Unadjusted 1-year mortality was lower in academic hospitals for ST-elevation myocardial infarction (STEMI) (10% vs. 15%, P=.01).
  • Patients in hospitals with percutaneous coronary intervention (PCI) capability were more likely to receive reperfusion and recommended therapies.
  • After adjusting for baseline characteristics and therapies, admission to nonacademic hospitals without PCI capability was associated with higher mortality for STEMI patients (HR 1.65, 95% CI 1.09-2.49).

Conclusions:

  • Academic hospital admission was linked to more frequent use of recommended therapies.
  • This increased use of therapies conferred a survival advantage for ST-elevation myocardial infarction (STEMI) patients.
Abstract

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