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Admission to hospitals with on-site cardiac catheterization facilities :impact on long-term costs and outcomes
H M Krumholz1, J Chen, J E Murillo
1Section of Cardiovascular Medicine, Department of Medicine, Section of Chronic Disease Epidemiology, Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, CT 06520-8025, USA. harlan.krumholz@Yale.edu
Insights
Elderly patients with heart attacks admitted to hospitals with cardiac catheterization facilities had lower readmission rates but similar long-term costs and mortality compared to those admitted to hospitals without these capabilities.
Area of Science:
- Cardiology
- Health Services Research
- Geriatric Medicine
Background:
- Hospital capability for cardiac procedures influences referral rates but not short-term outcomes.
- Long-term mortality and resource consumption differences remain unclear.
- Investigating the impact of on-site cardiac catheterization facilities on elderly acute myocardial infarction patients is crucial.
Purpose of the Study:
- To determine if elderly Medicare patients with acute myocardial infarction (AMI) admitted to hospitals with on-site cardiac catheterization facilities experience lower long-term hospital costs and better outcomes.
- To compare mortality rates and resource utilization between hospitals with and without on-site cardiac catheterization.
Main Methods:
- Retrospective cohort study using medical charts and administrative data from the Cooperative Cardiovascular Project pilot in Connecticut.
- Included 2521 Medicare patients with AMI from 1992-1993.
- Compared outcomes and costs for patients admitted to hospitals with versus without on-site cardiac catheterization facilities.
Main Results:
- Hospitals with facilities had higher cardiac catheterization rates (38.6% vs. 26.9%), but similar revascularization rates.
- Mortality rates at 30 days and 3 years were similar between the two groups.
- Adjusted readmission rates were significantly lower in hospitals with facilities (OR, 0.76; 95% CI, 0.61 to 0.94).
- No significant difference in 3-year costs or mean hospital days was observed.
Conclusions:
- Admission to hospitals with on-site cardiac catheterization facilities is associated with higher catheterization rates and lower readmissions.
- These admissions do not lead to significantly different long-term hospital costs or mortality rates.
- Patient outcomes and resource utilization are comparable regardless of facility presence for AMI patients.
Background:
Admission to a hospital with a 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. Whether there are differences in long-term mortality and resource consumption is not clear. We sought to determine whether elderly Medicare patients with acute myocardial infarction admitted to hospitals with on-site cardiac catheterization facilities have lower long-term hospital costs and better outcomes than patients admitted to hospitals without such facilities.
Methods And Results:
As part of the Cooperative Cardiovascular Project pilot in Connecticut, we conducted a retrospective cohort study using data from medical charts and administrative files. The study sample included 2521 patients with acute myocardial infarction covered by Medicare from 1992 to 1993. The cardiac catheterization rate was higher in the hospitals with facilities (38.6% versus 26.9%; P<0.001), but the revascularization rate was similar (20.5% versus 19.5%) during the initial episode of care and at 3 years (29.7% versus 29.7%). Mortality rates were similar for patients admitted to the 2 types of hospitals at 30 days (OR, 1.08; 95% CI, 0.83 to 1.42) and at 3 years (OR, 1.02; 95% CI, 0.83 to 1.26). The adjusted readmission rates were significantly lower among patients admitted to hospitals with cardiac catheterization facilities (OR, 0.76; 95% CI, 0.61 to 0.94). However, the overall mean days in the hospital for the 3 years after admission was 25.9 for patients admitted to hospitals with facilities and 24.6 for the other patients (P=0.234). Adjusting for baseline patient characteristics, there was no significant difference in the 3-year costs between patients admitted to the 2 types of hospitals.
Conclusions:
With higher rates of cardiac catheterization and lower readmission rates, patients admitted to hospitals with on-site cardiac catheterization facilities did not have significantly different hospital costs compared with patients admitted to hospitals without these facilities. There was also no significant difference in short- or long-term mortality rates.