Outcomes and transfer patterns for first Non-ST-elevation myocardial infarction (NSTEMI): comparisons between
Tara L Sedlak1, Min Gao2, May Lee2
1Vancouver General Hospital, Vancouver, British Columbia, Canada.
Insights
Patients with non-ST-segment elevation myocardial infarction (NSTEMI) admitted to community hospitals had similar mortality to those in tertiary care. However, nonremote community hospitals showed lower readmission rates for acute myocardial infarction or death.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Understanding patient transfer patterns, procedure rates, and outcomes for non-ST-segment elevation myocardial infarction (NSTEMI) in Canadian community hospitals is limited.
- NSTEMI care in diverse hospital settings requires further investigation.
Purpose of the Study:
- To compare transfer rates, procedure utilization, and patient outcomes (mortality, readmission) for NSTEMI patients across different hospital types in British Columbia.
- To assess the impact of admitting hospital type (tertiary, nonremote community, remote community) on NSTEMI patient management and outcomes.
Main Methods:
- Retrospective analysis of NSTEMI admissions to British Columbia hospitals between 2007-2008.
- Categorization of hospitals into tertiary care, nonremote community, and remote community settings.
- Comparison of transfer rates, time to transfer, procedure rates, and 1-year outcomes including mortality and composite endpoints.
Main Results:
- Transfer rates to tertiary hospitals were higher from nonremote (72.6%) than remote (57.1%) community hospitals.
- Significant differences observed in cardiac procedure rates across the three hospital types.
- One-year mortality was similar across all hospital types; however, nonremote community hospitals showed a lower composite outcome of death or acute myocardial infarction readmission.
Conclusions:
- No significant difference in 1-year mortality for NSTEMI patients admitted to community versus tertiary care hospitals.
- Nonremote community hospitals demonstrated a significant reduction in the composite outcome of death or readmission for acute myocardial infarction.
- Findings suggest evaluating NSTEMI care processes and outcomes in community hospital settings nationwide.
Background:
Transfer patterns, procedure rates, and outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) presenting to Canadian community hospitals are not well understood.
Methods:
We documented all patients admitted to British Columbia (BC) hospitals with a primary diagnosis of NSTEMI between 2007 and 2008. Patients were divided by admitting hospital type into tertiary care hospitals, nonremote community hospitals, and remote community hospitals. The aims were to compare transfer rates and time to transfer to a tertiary hospital as well as procedure rates and outcomes at index admission, at 30 days, and at 1 year.
Results:
The mean transfer rates to a tertiary hospital were 72.6% for nonremote and 57.1% for remote community hospitals (P < 0.001). Times to and rates of cardiac procedures differed significantly among these 3 hospital types. Admission to a nonremote or remote community hospital was associated with similar 1-year mortality compared with admission to a tertiary care hospital (nonremote hospitals, adjusted odds ratio [OR], 0.87; P = 0.26; remote hospitals, adjusted OR, 1.19; P = 0.33). At 1 year, admission to a nonremote community hospital was associated with a lower composite outcome of death or readmission for acute myocardial infarction (AMI) (adjusted OR, 0.80; P = 0.04).
Conclusions:
One-year mortality rates were not different between patients with NSTEMI admitted to BC community and tertiary care hospitals; however, the rate of readmission for AMI/death was significantly less in patients admitted to nonremote community hospitals. This should prompt the evaluation of key outcomes in NSTEMI in other community hospital settings.
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