S'abonner

Quality of Care for Myocardial Infarction at Academic and Nonacademic Hospitals - 23/03/12

Doi : 10.1016/j.amjmed.2011.11.015 
Loic Belle, MD a, José Labarère, MD b, c, , Magali Fourny, MSc c, Elodie Drouet, MSc d, Geneviève Mulak, PharmD e, Jean-Jacques Dujardin, MD f, Didier Vilarem, MD g, Philippe Bonnet, MD h, Michel Hanssen, MD i, Tabassome Simon, MD, PhD d, j, Jean Ferrières, MD, PhD k, l, Nicolas Danchin, MD, PhD m, n

French registry of Acute ST elevation or non-ST-elevation Myocardial Infarction study investigators

a Department of Cardiology, Annecy General Hospital, France 
b TIMC, UMR 5525, CNRS, Université Joseph Fourier, Grenoble 1, France 
c Quality of Care Unit, Grenoble University Hospital, France 
d URC-EST, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, France 
e Société Française de Cardiologie, Paris, France 
f Department of Cardiology, Douai General Hospital, France 
g Department of Cardiology, Valenciennes General Hospital, France 
h Department of Cardiology, Le Havre General Hospital, France 
i Department of Cardiology, Hagueneau General Hospital, France 
j Université Pierre et Marie Curie, Paris 6, France 
k Department of Cardiology, Toulouse University Hospital, France 
l UMR 558, INSERM, Université Paul Sabatier, Toulouse, France 
m Division of Coronary Artery Disease and Intensive Cardiac Care, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, France 
n Université Paris Descartes, Paris 5, France 

Requests for reprints should be addressed to José Labarère, MD, Quality of Care Unit, Pavillon Taillefer, CHU BP 217, 38043 Grenoble Cedex 9, France

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.
 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.
 Authorship: All authors had access to the data and played a role in writing this manuscript.


© 2012  Elsevier Inc. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

  • Contenu

Vol 125 - N° 4

P. 365-373 - avril 2012 Retour au numéro
Article précédent Article précédent
  • Variation in Use of Head Computed Tomography by Emergency Physicians
  • Luciano M. Prevedello, Ali S. Raja, Richard D. Zane, Aaron Sodickson, Stuart Lipsitz, Louise Schneider, Richard Hanson, Srinivasan Mukundan, Ramin Khorasani
| Article suivant Article suivant
  • Sleep Apnea and Risk of Deep Vein Thrombosis: A Non-randomized, Pair-matched Cohort Study
  • Kun-Ta Chou, Chin-Chou Huang, Yuh-Min Chen, Kang-Cheng Su, Guang-Ming Shiao, Yu-Chin Lee, Wan-Leong Chan, Hsin-Bang Leu

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

Mon compte


Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.


Tout le contenu de ce site: Copyright © 2024 Elsevier, ses concédants de licence et ses contributeurs. Tout les droits sont réservés, y compris ceux relatifs à l'exploration de textes et de données, a la formation en IA et aux technologies similaires. Pour tout contenu en libre accès, les conditions de licence Creative Commons s'appliquent.