The Erne Mobile Intensive Coronary Care Study : Mortality, survival and MICCU

Area of Science:

• Cardiology
• Public Health
• Health Services Research

Background:

• The Erne Mobile Intensive Care Unit (MICCU) study evaluated its initial year of operation in Co. Fermanagh.
• Assessing the impact of MICCU on mortality and survival rates for acute myocardial infarction (AMI) is crucial for healthcare quality improvement.

Purpose of the Study:

• To measure in-hospital mortality from AMI based on WHO criteria.
• To identify factors influencing mortality and survival in AMI patients.
• To evaluate the performance of the MICCU.

Main Methods:

• Analysis of 297 first admissions for suspected AMI to the Coronary Care Unit (CCU) between 1983-1984.
• Collection and analysis of 28 variables, including demographic data, medical history, clinical status, treatment, and outcome.
• Utilized multi-factor mortality analysis and the MPR Weibull model for survival analysis.

Main Results:

• Of 297 first admissions, 170 (57.2%) had AMI; 42 (14.1%) died before discharge.
• Crude and 28-day mortality were significantly worse in the AMI group.
• MICCU transport was faster (average 5h) but did not reduce deaths compared to standard ambulances.

Conclusions:

• No direct, statistically significant beneficial effect of MICCU on mortality or survival was found in multi-factor models.
• Crude survival improvements were observed after controlling for adverse case-mix, suggesting a potential small MICCU benefit.
• Findings pertain to the first year of operation; performance may improve in subsequent years.