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The effect of a regional care model on cardiac catheterization rates in patients with Acute Coronary Syndromes.

Curran HJ, Hubacek J, Southern D, Galbraith D, Knudtson ML, Ghali WA, Graham MM, APPROACH Investigato - BMC Health Serv Res (2014)

Bottom Line: Transfer to specialized cardiac procedural centers is necessary to provide access to these procedures.We evaluated a total of 6154 patients with ACS admitted to Southern Alberta hospitals (where a distinct regional care model for ACS exists) between January 1, 2005 and December 31, 2009.Thirty day and 1-year survival were also evaluated.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. mmg2@ualberta.ca.

ABSTRACT

Background: Patients with ACS often present to community hospitals without on-site cardiac catheterization and revascularization therapies. Transfer to specialized cardiac procedural centers is necessary to provide access to these procedures. We evaluated process of care within a regional care model by comparing cardiac catheterization and revascularization rates and outcomes in ACS patients presenting to community and interventional hospitals.

Methods: We evaluated a total of 6154 patients with ACS admitted to Southern Alberta hospitals (where a distinct regional care model for ACS exists) between January 1, 2005 and December 31, 2009. We compared cardiac catheterization and revascularization rates during index hospitalization among patients admitted to community and interventional hospitals. Thirty day and 1-year survival were also evaluated.

Results: Catheterization was performed more often in patients presenting to community hospitals compared to the interventional facility (respectively 69.5% and 51.4%, p < 0.0001). Catheterization within 72 hours of admission occurred in 48% of patients presenting to the interventional center and in 68.3% of community patients (P < 0.0001). In patients undergoing catheterization, revascularization (PCI and/or CABG) was also performed more frequently in the community group (74.5% vs 56.1%, P < 0.0001). Risk adjusted mortality rates were the same for patients undergoing cardiac catheterization regardless of hospital of initial presentation.

Conclusion: ACS patients presenting to community centers associated with a regional care model had effective access to cardiac catheterization and revascularization. These findings support the importance of regional initiatives and processes of care that facilitate access to cardiac catheterization for all ACS patients.

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Cardiac catheterization and revascularization rates by presenting hospital (Revascularization defined as percutaneous coronary intervention or coronary artery bypass grafting). Catheterization: Int 1,832 (51.4%) vs. comm 1,801 (69.5%), P<0.0001.Revascularization: Int 1,027 (56.1%) vs. comm 1,342 (74.5%), P<0.0.
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Fig1: Cardiac catheterization and revascularization rates by presenting hospital (Revascularization defined as percutaneous coronary intervention or coronary artery bypass grafting). Catheterization: Int 1,832 (51.4%) vs. comm 1,801 (69.5%), P<0.0001.Revascularization: Int 1,027 (56.1%) vs. comm 1,342 (74.5%), P<0.0.

Mentions: Figure 1 depicts cardiac catheterization and revascularization rates according to type of admitting hospital. Catheterization was performed more frequently in patients initially admitted to community hospitals than those admitted initially to the interventional facility (respectively 69.5% and 51.4%, p < 0.0001). In patients undergoing catheterization, revascularization (PCI and/or CABG) was also performed more frequently in the community group compared to the interventional group (respectively, 74.5% and 56.1%, P < 0.0001). The overall mean time to cardiac catheterization was 3.2 days. Patients admitted to the interventional center underwent catheterization sooner than those admitted to community centers (2.6 vs. 4 days, p < 0.001). In the interventional group, 9.8% underwent catheterization within 24 hours of admission compared to 16.7% in the community group. Within 48 hours from admission, 32.5% and 54.3% of the interventional and community patients underwent catheterization and within 72 hours, 48% and 68.3% had undergone the procedure (p < 0.0001).Figure 1


The effect of a regional care model on cardiac catheterization rates in patients with Acute Coronary Syndromes.

Curran HJ, Hubacek J, Southern D, Galbraith D, Knudtson ML, Ghali WA, Graham MM, APPROACH Investigato - BMC Health Serv Res (2014)

Cardiac catheterization and revascularization rates by presenting hospital (Revascularization defined as percutaneous coronary intervention or coronary artery bypass grafting). Catheterization: Int 1,832 (51.4%) vs. comm 1,801 (69.5%), P<0.0001.Revascularization: Int 1,027 (56.1%) vs. comm 1,342 (74.5%), P<0.0.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230349&req=5

Fig1: Cardiac catheterization and revascularization rates by presenting hospital (Revascularization defined as percutaneous coronary intervention or coronary artery bypass grafting). Catheterization: Int 1,832 (51.4%) vs. comm 1,801 (69.5%), P<0.0001.Revascularization: Int 1,027 (56.1%) vs. comm 1,342 (74.5%), P<0.0.
Mentions: Figure 1 depicts cardiac catheterization and revascularization rates according to type of admitting hospital. Catheterization was performed more frequently in patients initially admitted to community hospitals than those admitted initially to the interventional facility (respectively 69.5% and 51.4%, p < 0.0001). In patients undergoing catheterization, revascularization (PCI and/or CABG) was also performed more frequently in the community group compared to the interventional group (respectively, 74.5% and 56.1%, P < 0.0001). The overall mean time to cardiac catheterization was 3.2 days. Patients admitted to the interventional center underwent catheterization sooner than those admitted to community centers (2.6 vs. 4 days, p < 0.001). In the interventional group, 9.8% underwent catheterization within 24 hours of admission compared to 16.7% in the community group. Within 48 hours from admission, 32.5% and 54.3% of the interventional and community patients underwent catheterization and within 72 hours, 48% and 68.3% had undergone the procedure (p < 0.0001).Figure 1

Bottom Line: Transfer to specialized cardiac procedural centers is necessary to provide access to these procedures.We evaluated a total of 6154 patients with ACS admitted to Southern Alberta hospitals (where a distinct regional care model for ACS exists) between January 1, 2005 and December 31, 2009.Thirty day and 1-year survival were also evaluated.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. mmg2@ualberta.ca.

ABSTRACT

Background: Patients with ACS often present to community hospitals without on-site cardiac catheterization and revascularization therapies. Transfer to specialized cardiac procedural centers is necessary to provide access to these procedures. We evaluated process of care within a regional care model by comparing cardiac catheterization and revascularization rates and outcomes in ACS patients presenting to community and interventional hospitals.

Methods: We evaluated a total of 6154 patients with ACS admitted to Southern Alberta hospitals (where a distinct regional care model for ACS exists) between January 1, 2005 and December 31, 2009. We compared cardiac catheterization and revascularization rates during index hospitalization among patients admitted to community and interventional hospitals. Thirty day and 1-year survival were also evaluated.

Results: Catheterization was performed more often in patients presenting to community hospitals compared to the interventional facility (respectively 69.5% and 51.4%, p < 0.0001). Catheterization within 72 hours of admission occurred in 48% of patients presenting to the interventional center and in 68.3% of community patients (P < 0.0001). In patients undergoing catheterization, revascularization (PCI and/or CABG) was also performed more frequently in the community group (74.5% vs 56.1%, P < 0.0001). Risk adjusted mortality rates were the same for patients undergoing cardiac catheterization regardless of hospital of initial presentation.

Conclusion: ACS patients presenting to community centers associated with a regional care model had effective access to cardiac catheterization and revascularization. These findings support the importance of regional initiatives and processes of care that facilitate access to cardiac catheterization for all ACS patients.

Show MeSH