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Effectiveness of coronary care units in small community hospitals

J K Stross, P W Willis, E W Reynolds

    Annals of Internal Medicine
    |December 1, 1976
    PubMed

    Insights

    Coronary care units in small hospitals provide adequate care, but performance declines with fewer than 60 acute myocardial infarction admissions annually. This finding impacts cardiac patient outcomes in community settings.

    Area of Science:

    • Cardiology
    • Health Services Research

    Background:

    • Coronary care units (CCUs) aim to improve outcomes for acute myocardial infarction (AMI) patients.
    • The effectiveness of CCUs in small community hospitals compared to larger facilities requires evaluation.

    Purpose of the Study:

    • To assess the performance of CCUs established in small community hospitals.
    • To compare mortality rates and risk-adjusted outcomes in small versus larger hospitals.

    Main Methods:

    • Prospective study conducted from 1969 to 1974.
    • Analysis included crude mortality rates, multivariate discriminate analysis for risk scores, and comparison of observed versus expected deaths.
    • Data stratified by hospital size and annual patient volume.

    Main Results:

    • Crude AMI mortality in small hospitals (14.5%) was not statistically different from larger hospitals (11.5%).
    • Risk-adjusted analysis showed observed deaths exceeded expected deaths in small hospitals, while larger hospitals had fewer observed than expected deaths.
    • Mortality was significantly higher in CCUs with <60 AMI admissions/year (20.9%) versus those with >60 admissions/year (10.7%).

    Conclusions:

    • CCUs in small community hospitals can deliver adequate coronary care.
    • Hospital volume is a critical factor; performance decreases significantly below 60 AMI admissions annually.
    • These findings highlight the importance of patient volume for maintaining CCU effectiveness in community settings.

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