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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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Related in: MedlinePlus

Kaplan Meier plot demonstrating survival from admission with acute coronary syndrome stratified by cardiac catheterization status (C = community hospitals, M = metropolitan hospitals, I = interventional hospital, cath = cardiac catheterization).
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Fig2: Kaplan Meier plot demonstrating survival from admission with acute coronary syndrome stratified by cardiac catheterization status (C = community hospitals, M = metropolitan hospitals, I = interventional hospital, cath = cardiac catheterization).

Mentions: Figure 2 demonstrates Kaplan Meier survival curves extending to one year of follow up. There was an early separation of the curves that persisted with longer follow-up, with crude mortality rates significantly lower in patients undergoing cardiac catheterization in both community (12.7% vs. 3.5%) and interventional (9.1% vs. 4.2%) centers p < 0.0001. Survival was lower for patients not referred for catheterization from an admitting community hospital compared to patients first admitted to the interventional center but not referred for catheterization (87.3% vs. 90.9%, p = 0.003).Figure 2


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)

Kaplan Meier plot demonstrating survival from admission with acute coronary syndrome stratified by cardiac catheterization status (C = community hospitals, M = metropolitan hospitals, I = interventional hospital, cath = cardiac catheterization).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Kaplan Meier plot demonstrating survival from admission with acute coronary syndrome stratified by cardiac catheterization status (C = community hospitals, M = metropolitan hospitals, I = interventional hospital, cath = cardiac catheterization).
Mentions: Figure 2 demonstrates Kaplan Meier survival curves extending to one year of follow up. There was an early separation of the curves that persisted with longer follow-up, with crude mortality rates significantly lower in patients undergoing cardiac catheterization in both community (12.7% vs. 3.5%) and interventional (9.1% vs. 4.2%) centers p < 0.0001. Survival was lower for patients not referred for catheterization from an admitting community hospital compared to patients first admitted to the interventional center but not referred for catheterization (87.3% vs. 90.9%, p = 0.003).Figure 2

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
Related in: MedlinePlus