Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2013;66:935-42 - Vol. 66 Num.12 DOI: 10.1016/j.rec.2013.06.006

In-hospital Mortality Due to Acute Myocardial Infarction. Relevance of Type of Hospital and Care Provided. RECALCAR Study

Vicente Bertomeu a, Ángel Cequier b, José L. Bernal c, Fernando Alfonso d, Manuel P. Anguita e, Javier Muñiz f, José A. Barrabés g, David García-Dorado g, Javier Goicolea h, Francisco J. Elola i,

a Servicio de Cardiología, Hospital San Juan, Universidad Miguel Hernández, Alicante, Spain
b Àrea de Malalties del Cor, Hospital Universitari de Bellvitge, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
c Control de Gestión, Hospital 12 de Octubre, Madrid, Spain
d Departamento de Cardiología Intervencionista, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
e Servicio de Cardiología, Hospital Reina Sofía, Córdoba, Spain
f Instituto de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain
g Servicio de Cardiología, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
h Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
i Elola Consultores, Madrid, Spain

Keywords

Myocardial infarction. In-hospital mortality. Hospital organization. Reperfusion. Coronary angioplasty. Percutaneous coronary intervention.

Abstract

Introduction and objectives

To investigate the relationship between in-hospital mortality due to acute myocardial infarction and type of hospital, discharge service, and treatment provided.

Methods

Retrospective analysis of 100 993 hospital discharges with a principal diagnosis of myocardial infarction in hospitals of the Spanish National Health Service. In-hospital mortality was adjusted for risk following the models of the Institute for Clinical Evaluative Sciences (Canada) and the Centers for Medicare & Medicaid Services (United States).

Results

Hospital characteristics are relevant to explain the variation in the individual probability of dying from myocardial infarction (median odds ratio: 1.3561). The risk-adjusted in-hospital mortality in cluster 3 and especially in cluster 4 hospitals (500 beds to 1000 beds and medium-high complexity) was significantly lower than in hospitals with less than 200 beds. Cluster 5 (more than 1000 beds), which includes a diverse group of hospitals, had a higher mortality rate than clusters 3 and 4. The adjusted mortality in the groups with the best and worst outcomes was 6.74% (cluster 4) and 8.49% (cluster 1), respectively. Mortality was also lower when the cardiology unit was responsible for the discharge or when angioplasty had been performed.

Conclusions

The typology of the hospital, treatment in a cardiology unit, and percutaneous coronary intervention are significantly associated with the survival of a patient hospitalized for myocardial infarction. We recommend that the Spanish National Health Service establish health care networks that favor percutaneous coronary intervention and the participation of cardiology units in the management of patients with acute myocardial infarction.

1885-5857/© 2013 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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