MedWire News: The benefit of regionalizing care of acute myocardial infarction (AMI) patients to hospitals capable of performing percutaneous coronary intervention (PCI) depends on the hospital referral region.
So say researchers who looked at the outcomes of a total of 718,028 Medicare beneficiaries aged 65 years or older who were hospitalized with AMI at 3873 hospitals between 1 January 2004 and 31 December 2006.
They report in the Archives of Internal Medicine that 30-day mortality was significantly lower among the 523,119 patients admitted to 1382 PCI hospitals than among 194,909 patients admitted to 2491 non-PCI hospitals. The odds ratio was 0.89 after adjusting for age, gender, and comorbidities.
But, although PCI hospitals had on average lower 30-day risk-standardized mortality rates (RSMRs) than non-PCI hospitals (16.1% vs 16.9%, p<0.001), RSMRs varied widely among PCI hospitals (range 10.8–23.8%) and non-PCI hospitals (12.6–23.0%), leading to substantial overlap between the two hospital groups.
And on a regional level, while RSMRs at the best-performing PCI hospital were 3% or more lower than at local non-PCI hospitals in 80 of 295 hospital referral regions, RSMRs were no better or even higher at best-performing PCI hospitals than at local non-PCI hospitals in 37 hospital referral regions.
“Our study illustrates the complexity surrounding decisions to comprehensively regionalize AMI care in the [USA],” comment Jersey Chen (Yale University, New Haven, Connecticut, USA) and co-authors.
They add that the variation in differences in RSMRs across hospital referral regions “reinforces the need to carefully examine outcomes on a region-by-region basis before embarking on strategies to direct all AMI care to PCI hospitals.”
Chen and colleagues believe the findings support a “tailored regionalization policy that targets areas with the greatest outcome differences between PCI and local non-PCI hospitals.”
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