The association between hospital department, medical treatment and outcome in acute myocardial infarction.
Isr Med Assoc J
; 5(4): 255-9, 2003 Apr.
Article
in En
| MEDLINE
| ID: mdl-14509129
ABSTRACT
BACKGROUND:
Although the preferred management of a patient presenting with an acute myocardial infarction is in a coronary care unit, data based on discharge diagnoses in Israel indicate that many of these patients are treated outside of such units.OBJECTIVES:
To compare the demographic and clinical characteristics, treatment and mortality of AMI patients treated inside and outside a CCU.METHODS:
We compiled a registry of all patients admitted to three general hospitals in Haifa, Israel during January, March, May, July, September and November 1996.RESULTS:
The non-CCU admission rate was 22%. CCU patients were younger (61.6 vs. 65.5 years), less likely to report a past AMI (18% vs. 34%), and arrived earlier at the emergency room. Non-CCU patients were more likely to present with severe heart failure (30 vs. 11%). Non-CCU patients received less aspirin (81 vs. 95%) and betablockers (62 vs. 80%). Upon discharge, these patients were less frequently prescribed beta-blockers and cardiac rehabilitation programs. CCU-treated patients had lower unadjusted mortality rates at both 30 days (odds ratio = 0.35) and in the long term (hazards ratio = 0.57). These ratios were attenuated after controlling for gender, age, type of AMI, and degree of heart failure (OR = 0.91 and HR = 0.78, respectively).CONCLUSIONS:
A relatively high proportion of AMI patients were treated outside a CCU, with older and sicker patients being denied admission to a CCU. The process of evidence-based care by cardiologists was preferable to that of internists both during the hospital stay and at discharge. In Israel a significant proportion of all AMI admissions are initially treated outside a CCU. Emphasis on increasing awareness in internal medicine departments to evidence-based care of AMI is indicated.
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Collection:
01-internacional
Database:
MEDLINE
Main subject:
Hospital Mortality
/
Coronary Care Units
/
Hospital Departments
/
Myocardial Infarction
Type of study:
Clinical_trials
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
Country/Region as subject:
Asia
Language:
En
Journal:
Isr Med Assoc J
Journal subject:
MEDICINA
Year:
2003
Document type:
Article
Affiliation country:
Israel