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Does interhospital transfer improve outcome of acute myocardial infarction? A propensity score analysis from the Cardiovascular Cooperative Project.
BMC Cardiovasc Disord. 2008 Sep 09; 8:22.BC

Abstract

BACKGROUND

Many patients suffering acute myocardial infarction (AMI) are transferred from one hospital to another during their hospitalization. There is little information about the outcomes related to interhospital transfer. The purpose of this study was to compare processes and outcomes of AMI care among patients undergoing interhospital transfer with special attention to the impact on mortality in rural hospitals.

METHODS

National sample of Medicare patients in the Cooperative Cardiovascular Study (n = 184,295). Retrospective structured medical record review of AMI hospitalizations. Descriptive study using a retrospective propensity score analysis of clinical and administrative data for 184,295 Medicare patients admitted with clinically confirmed AMI to 4,765 hospitals between February 1994 and July 1995. Main outcome measure included: 30-day mortality, administration of aspirin, beta-blockers, ACE-inhibitors, and thrombolytic therapy.

RESULTS

Overall, 51,530 (28%) patients underwent interhospital transfer. Transferred patients were significantly younger, less critically ill, and had lower comorbidity than non-transferred patients. After propensity-matching, patients who underwent interhospital transfer had better quality of care anlower mortality than non-transferred patients. Patients cared for in a rural hospital had similar mortality as patients cared for in an urban hospital.

CONCLUSION

Transferred patients were vastly different than non-transferred patients. However, even after a rigorous propensity-score analysis, transferred patients had lower mortality than non-transferred patients. Mortality was similar in rural and urban hospitals. Identifying patients who derive the greatest benefit from transfer may help physicians faced with the complex decision of whether to transfer a patient suffering an acute MI.

Authors+Show Affiliations

University of Colorado Denver - Anschutz Medical Campus, Denver, Colorado, USA. jack.westfall@uchsc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

18782452

Citation

Westfall, John M., et al. "Does Interhospital Transfer Improve Outcome of Acute Myocardial Infarction? a Propensity Score Analysis From the Cardiovascular Cooperative Project." BMC Cardiovascular Disorders, vol. 8, 2008, p. 22.
Westfall JM, Kiefe CI, Weissman NW, et al. Does interhospital transfer improve outcome of acute myocardial infarction? A propensity score analysis from the Cardiovascular Cooperative Project. BMC Cardiovasc Disord. 2008;8:22.
Westfall, J. M., Kiefe, C. I., Weissman, N. W., Goudie, A., Centor, R. M., Williams, O. D., & Allison, J. J. (2008). Does interhospital transfer improve outcome of acute myocardial infarction? A propensity score analysis from the Cardiovascular Cooperative Project. BMC Cardiovascular Disorders, 8, 22. https://doi.org/10.1186/1471-2261-8-22
Westfall JM, et al. Does Interhospital Transfer Improve Outcome of Acute Myocardial Infarction? a Propensity Score Analysis From the Cardiovascular Cooperative Project. BMC Cardiovasc Disord. 2008 Sep 9;8:22. PubMed PMID: 18782452.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does interhospital transfer improve outcome of acute myocardial infarction? A propensity score analysis from the Cardiovascular Cooperative Project. AU - Westfall,John M, AU - Kiefe,Catarina I, AU - Weissman,Norman W, AU - Goudie,Anthony, AU - Centor,Robert M, AU - Williams,O Dale, AU - Allison,Jeroan J, Y1 - 2008/09/09/ PY - 2007/10/30/received PY - 2008/09/09/accepted PY - 2008/9/11/pubmed PY - 2008/11/19/medline PY - 2008/9/11/entrez SP - 22 EP - 22 JF - BMC cardiovascular disorders JO - BMC Cardiovasc Disord VL - 8 N2 - BACKGROUND: Many patients suffering acute myocardial infarction (AMI) are transferred from one hospital to another during their hospitalization. There is little information about the outcomes related to interhospital transfer. The purpose of this study was to compare processes and outcomes of AMI care among patients undergoing interhospital transfer with special attention to the impact on mortality in rural hospitals. METHODS: National sample of Medicare patients in the Cooperative Cardiovascular Study (n = 184,295). Retrospective structured medical record review of AMI hospitalizations. Descriptive study using a retrospective propensity score analysis of clinical and administrative data for 184,295 Medicare patients admitted with clinically confirmed AMI to 4,765 hospitals between February 1994 and July 1995. Main outcome measure included: 30-day mortality, administration of aspirin, beta-blockers, ACE-inhibitors, and thrombolytic therapy. RESULTS: Overall, 51,530 (28%) patients underwent interhospital transfer. Transferred patients were significantly younger, less critically ill, and had lower comorbidity than non-transferred patients. After propensity-matching, patients who underwent interhospital transfer had better quality of care anlower mortality than non-transferred patients. Patients cared for in a rural hospital had similar mortality as patients cared for in an urban hospital. CONCLUSION: Transferred patients were vastly different than non-transferred patients. However, even after a rigorous propensity-score analysis, transferred patients had lower mortality than non-transferred patients. Mortality was similar in rural and urban hospitals. Identifying patients who derive the greatest benefit from transfer may help physicians faced with the complex decision of whether to transfer a patient suffering an acute MI. SN - 1471-2261 UR - https://www.unboundmedicine.com/medline/citation/18782452/Does_interhospital_transfer_improve_outcome_of_acute_myocardial_infarction_A_propensity_score_analysis_from_the_Cardiovascular_Cooperative_Project_ L2 - https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/1471-2261-8-22 DB - PRIME DP - Unbound Medicine ER -