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Hospital therapy traditions influence long-term survival in patients with acute myocardial infarction.
Am Heart J. 2005 Jan; 149(1):82-90.AH

Abstract

BACKGROUND

Differences in therapy and outcome among hospitals have been reported, but these studies have seldom used adjustment for differences in patient characteristics. The objective was to investigate the differences in treatment of acute myocardial infarction (AMI) among different hospitals within 1 country and the possible causes and outcomes of these differences.

METHODS

Prospective cohort study using data from the Register of Information and Knowledge about Swedish Heart Intensive care Admissions (RIKS-HIA) on 32,954 consecutive primary admissions of patients with AMI admitted to the intensive coronary care units of 67 Swedish hospitals in 1999-2000. An activity index was calculated for each hospital based on the hospital's ranking regarding proportion of performed examination or given therapy among the AMI patients.

RESULTS

After adjustment for 24 background characteristics, there were few significant deviations among hospitals in the proportion treated with acute reperfusion, antiplatelets, beta-blockers, or angiotensin-converting enzyme (ACE) inhibitors. However, 3- to 10-fold differences existed among hospitals in the proportion of patients treated with intravenous beta-blockers, intravenous nitroglycerin, intravenous or subcutaneous anticoagulants, and lipid-lowering medication, and even larger discrepancies in echocardiography and revascularization within 14 days. There was a strong (r = 0.69, P < .001) correlation between hospital activity index between the years and a correlation between the hospital's activity index and 1-year mortality (r = -0.30, P = .014). There was no correlation between hospital size and activity index.

CONCLUSIONS

Even after adjustment for differences in patient characteristics, there are differences between the hospital treatment cultures for patients with AMI that persists over time. Concerning everywhere-available treatment options, the treatment activity is independent of the size of the center. A more active treatment tradition is associated with a lower short- and long-term mortality in AMI patients.

Authors+Show Affiliations

Department of Cardiology, University Hospital of Linköping, Sweden. stenestrand@riks-hia.seNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15660038

Citation

Stenestrand, Ulf, et al. "Hospital Therapy Traditions Influence Long-term Survival in Patients With Acute Myocardial Infarction." American Heart Journal, vol. 149, no. 1, 2005, pp. 82-90.
Stenestrand U, Lindbäck J, Wallentin L. Hospital therapy traditions influence long-term survival in patients with acute myocardial infarction. Am Heart J. 2005;149(1):82-90.
Stenestrand, U., Lindbäck, J., & Wallentin, L. (2005). Hospital therapy traditions influence long-term survival in patients with acute myocardial infarction. American Heart Journal, 149(1), 82-90.
Stenestrand U, Lindbäck J, Wallentin L. Hospital Therapy Traditions Influence Long-term Survival in Patients With Acute Myocardial Infarction. Am Heart J. 2005;149(1):82-90. PubMed PMID: 15660038.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hospital therapy traditions influence long-term survival in patients with acute myocardial infarction. AU - Stenestrand,Ulf, AU - Lindbäck,Johan, AU - Wallentin,Lars, PY - 2005/1/22/pubmed PY - 2005/5/17/medline PY - 2005/1/22/entrez SP - 82 EP - 90 JF - American heart journal JO - Am Heart J VL - 149 IS - 1 N2 - BACKGROUND: Differences in therapy and outcome among hospitals have been reported, but these studies have seldom used adjustment for differences in patient characteristics. The objective was to investigate the differences in treatment of acute myocardial infarction (AMI) among different hospitals within 1 country and the possible causes and outcomes of these differences. METHODS: Prospective cohort study using data from the Register of Information and Knowledge about Swedish Heart Intensive care Admissions (RIKS-HIA) on 32,954 consecutive primary admissions of patients with AMI admitted to the intensive coronary care units of 67 Swedish hospitals in 1999-2000. An activity index was calculated for each hospital based on the hospital's ranking regarding proportion of performed examination or given therapy among the AMI patients. RESULTS: After adjustment for 24 background characteristics, there were few significant deviations among hospitals in the proportion treated with acute reperfusion, antiplatelets, beta-blockers, or angiotensin-converting enzyme (ACE) inhibitors. However, 3- to 10-fold differences existed among hospitals in the proportion of patients treated with intravenous beta-blockers, intravenous nitroglycerin, intravenous or subcutaneous anticoagulants, and lipid-lowering medication, and even larger discrepancies in echocardiography and revascularization within 14 days. There was a strong (r = 0.69, P < .001) correlation between hospital activity index between the years and a correlation between the hospital's activity index and 1-year mortality (r = -0.30, P = .014). There was no correlation between hospital size and activity index. CONCLUSIONS: Even after adjustment for differences in patient characteristics, there are differences between the hospital treatment cultures for patients with AMI that persists over time. Concerning everywhere-available treatment options, the treatment activity is independent of the size of the center. A more active treatment tradition is associated with a lower short- and long-term mortality in AMI patients. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/15660038/Hospital_therapy_traditions_influence_long_term_survival_in_patients_with_acute_myocardial_infarction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002870304004545 DB - PRIME DP - Unbound Medicine ER -