Abstract 13759: Academic & Community Hospital Management of Acute Myocardial Infarction & Heart Failure: An EFFECT Trial Substudy
Background: Prevous studies suggest that practice and outcome differences exist between teaching and community hospitals. We investigated whether the quality of care of acute myocardial infarction (AMI) and heart failure (HF) differs according to hospital teaching status.
Methods: We performed a retrospective analysis of the Enhanced Feedback for Effective Cardiac Treatment [EFFECT] trial database (April 1, 2004 to March 31, 2005) to compare the quality of AMI and HF care and outcomes between teaching hospitals (TH; n=10) and community hospitals (CH; n=72) in Ontario, Canada.
Results: Of the eligible 1862 and 6027 AMI patients presenting to teaching and community hospitals, respectively, the majority were treated with thrombolytic therapy (TH: 74.4%; CH: 95.7%). Use of ASA and beta-blockers at initial presentation were similar at both hospital types. However, teaching hospitals were more likely to prescribe patients with recommended medications at discharge (Table). AMI patients presenting to teaching hospitals had higher Grace Risk Scores (TH: 146; CH: 143; p<0.001). Risk-adjusted mortality rates were similar 1 year post-discharge regardless of hospital type (TH: 22.5 (CI 20.9 – 24.0); CH: 20.5 (CI 19.6 – 21.3)). A total of 1915 and 6424 HF patients presented to teaching and community hospitals, respectively. During admission, teaching hospitals provided more measurements of left ventricular function and daily weights (Table). Both were similar in discharge prescriptions of ACE inhibitors/ARBs, beta-blockers and warfarin (Table). HF patients presenting to teaching hospitals had higher EFFECT-HF risk scores (TH: 102; CH: 100; p<0.001). Risk-adjusted mortality rates were similar 1 year post-discharge (TH: 35.9 (CI 33.9 – 37.8); CH: 34.1 (CI 33.0 – 35.2)).
Conclusion: Teaching hospitals treated higher risk AMI and HF patients but performed better on some process of care indicators than community hospitals. Overall mortality rates were similar.
- © 2010 by American Heart Association, Inc.