Mortality from myocardial infarction in different types of hospitals

Hospitals ranging from large urban teaching hospitals to small country hospitals were stratified into four levels of care and examined for their effectiveness of coronary care in relation to these levels. The crude hospital mortality among 2265 patients admitted for definite or possible acute myocardial infarction was 21% at level 1 (the most elaborate level), 22% at level 2, 21% at level 3, and 19% at level 4 (the least elaborate). Adjustment for age or other prognostic factors produced no significant differences across levels either for coronary care unit care or for combined coronary unit and ward care. Success in resuscitation was also similar across levels. These findings suggest that increased resources for coronary care units--whether for new services or for upgrading existing ones--may not be required.