Quality of Care for Myocardial Infarction at Academic and Nonacademic Hospitals - 23/03/12
French registry of Acute ST elevation or non-ST-elevation Myocardial Infarction study investigators
Abstract |
Background |
Whether academic hospitals provide better quality of care for patients with acute myocardial infarction is widely debated. The aim of this study was to compare processes of care and mortality between academic and nonacademic hospitals in the contemporary era of acute myocardial infarction management.
Methods |
We analyzed the original data from a prospective cohort study of 3059 patients, including 1714 with ST-segment elevation and 1345 with non-ST-segment elevation myocardial infarction, enrolled at 39 and 183 academic and nonacademic hospitals, respectively, in France.
Results |
Unadjusted 1-year mortality for academic and nonacademic hospitals was 10% versus 15% for patients with ST-segment elevation myocardial infarction (P=.01) and 13% versus 14% for patients with non-ST-segment elevation myocardial infarction (P=.75). Patients treated in academic or nonacademic hospitals with percutaneous coronary intervention capability were more likely to receive reperfusion and recommended drug therapies than those treated in nonacademic hospitals without percutaneous coronary intervention capability. After adjusting for baseline characteristics, the hazards of death associated with admission to nonacademic hospitals with and without percutaneous coronary intervention capability relative to academic hospitals were 1.13 (95% confidence interval [CI], 0.79-1.62) and 1.65 (95% CI, 1.09-2.49) for those with ST-segment elevation myocardial infarction and 0.95 (95% CI, 0.66-1.36) and 1.06 (95% CI, 0.72-1.58) for those with non-ST-segment elevation myocardial infarction, respectively. Further adjustment for receipt of acute reperfusion and recommended drug therapies eliminated all differences in mortality between the study groups.
Conclusion |
Admission to academic hospitals was associated with a more frequent use of recommended therapies, conveying a survival advantage for patients with ST-segment elevation myocardial infarction.
Le texte complet de cet article est disponible en PDF.Keywords : Academic medical centers, Mortality, Myocardial infarction, Quality of health care
Plan
Funding: The French registry of Acute ST elevation or non-ST-elevation Myocardial Infarction study was promoted by the French Society of Cardiology and supported by unrestricted educational grants from Pfizer and Servier and a research grant from the Caisse Nationale d'Assurance Maladie, Paris, France. |
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Conflicts of Interest: ND has received research grants from Astra-Zeneca, Eli-Lilly, Merck, Pfizer, Sanofi-Aventis, Servier, and The Medicines Company. ND also has received fees for speaking in industry-sponsored symposia and consulting for AstraZeneca, Bristol-Myers Squibb, Boehringer-Ingelheim, GlaxoSmithKline, Lilly, Menarini, MSD-Schering, Novartis, Novo, Pfizer, Sanofi-Aventis, Servier, and The Medicines Company. TS has received research grants from Pfizer and Servier. TS also has received fees for consulting or for sponsored symposia from AstraZeneca, Lilly, Sanofi-Aventis, and Bayer-Schering. MH has received research grants from Astra-Zeneca. The other authors have no conflict of interest relevant to this study. |
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Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 125 - N° 4
P. 365-373 - avril 2012 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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