Outcome of patients with acute coronary syndrome in hospitals of different sizes. A report from the AMIS Plus Registry.
Details
State: Public
Version: Final published version
Serval ID
serval:BIB_234BB589F839
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Outcome of patients with acute coronary syndrome in hospitals of different sizes. A report from the AMIS Plus Registry.
Journal
Swiss medical weekly
Working group(s)
AMIS Plus Investigators
Contributor(s)
Hess F., Simon R., Hangartner P.J., Lessing P., Hufschmid U., Hunziker P., Grädel C., Schönfelder A., Windecker S., Schläpfer H., Evéquoz D., Vögele A., Ryser D., Müller P., Jecker R., Niedermaier G., Droll A., Hongler T., Stäuble S., Haarer J., Schmid H.P., Quartenoud B., Bietenhard K., Gaspoz J.M., Keller P.F., Wojtyna W., Oertli B., Schönenberger R., Simonin C., Waldburger R., Schmidli M., Weiss E.M., Marty H., Zender H., Steffen C., Hugi A., Koltai E., Pedrazzini G., Erne P., Luterbacher T., Jordan B., Pagnamenta A., Urban P., Feraud P., Beretta E., Stettler C., Repond F., Widmer F., Lusser H., Polikar R., Bassetti S., Iselin H.U., Giger M., Egger P., Kaeslin T., Frey R., Herren T., Eichhorn P., Neumeier C., Grêt A., Schöneneberger R., Rickli H., Yoon S., Loretan P., Stoller U., Veragut U.P., Bächli E., Weber A., Federspiel B., Weisskopf M., Schmidt D., Hellermann J., Graber M., Haller A., Peter M., Gasser S., Siegrist P., Fatio R., Vogt M., Ramsay D., Bertel O., Maggiorini M., Eberli F., Christen S.
ISSN
1424-3997 (Electronic)
ISSN-L
0036-7672
Publication state
Published
Issued date
29/05/2010
Peer-reviewed
Oui
Volume
140
Number
21-22
Pages
314-322
Language
english
Notes
Publication types: Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Abstract
To assess the impact of admission to different hospital types on early and 1-year outcomes in patients with acute coronary syndrome (ACS).
Between 1997 and 2009, 31 010 ACS patients from 76 Swiss hospitals were enrolled in the AMIS Plus registry. Large tertiary institutions with continuous (24 hour/7 day) cardiac catheterisation facilities were classified as type A hospitals, and all others as type B. For 1-year outcomes, a subgroup of patients admitted after 2005 were studied.
Eleven type A hospitals admitted 15987 (52%) patients and 65 type B hospitals 15023 (48%) patients. Patients admitted into B hospitals were older, more frequently female, diabetic, hypertensive, had more severe comorbidities and more frequent non-ST segment elevation (NSTE)-ACS/unstable angina (UA). STE-ACS patients admitted into B hospitals received more thrombolysis, but less percutaneous coronary intervention (PCI). Crude in-hospital mortality and major adverse cardiac events (MACE) were higher in patients from B hospitals. Crude 1-year mortality of 3747 ACS patients followed up was higher in patients admitted into B hospitals, but no differences were found for MACE. After adjustment for age, risk factors, type of ACS and comorbidities, hospital type was not an independent predictor of in-hospital mortality, in-hospital MACE, 1-year MACE or mortality. Admission indicated a crude outcome in favour of hospitalisation during duty-hours while 1-year outcome could not document a significant effect.
ACS patients admitted to smaller regional Swiss hospitals were older, had more severe comorbidities, more NSTE-ACS and received less intensive treatment compared with the patients initially admitted to large tertiary institutions. However, hospital type was not an independent predictor of early and mid-term outcomes in these patients. Furthermore, our data suggest that Swiss hospitals have been functioning as an efficient network for the past 12 years.
Between 1997 and 2009, 31 010 ACS patients from 76 Swiss hospitals were enrolled in the AMIS Plus registry. Large tertiary institutions with continuous (24 hour/7 day) cardiac catheterisation facilities were classified as type A hospitals, and all others as type B. For 1-year outcomes, a subgroup of patients admitted after 2005 were studied.
Eleven type A hospitals admitted 15987 (52%) patients and 65 type B hospitals 15023 (48%) patients. Patients admitted into B hospitals were older, more frequently female, diabetic, hypertensive, had more severe comorbidities and more frequent non-ST segment elevation (NSTE)-ACS/unstable angina (UA). STE-ACS patients admitted into B hospitals received more thrombolysis, but less percutaneous coronary intervention (PCI). Crude in-hospital mortality and major adverse cardiac events (MACE) were higher in patients from B hospitals. Crude 1-year mortality of 3747 ACS patients followed up was higher in patients admitted into B hospitals, but no differences were found for MACE. After adjustment for age, risk factors, type of ACS and comorbidities, hospital type was not an independent predictor of in-hospital mortality, in-hospital MACE, 1-year MACE or mortality. Admission indicated a crude outcome in favour of hospitalisation during duty-hours while 1-year outcome could not document a significant effect.
ACS patients admitted to smaller regional Swiss hospitals were older, had more severe comorbidities, more NSTE-ACS and received less intensive treatment compared with the patients initially admitted to large tertiary institutions. However, hospital type was not an independent predictor of early and mid-term outcomes in these patients. Furthermore, our data suggest that Swiss hospitals have been functioning as an efficient network for the past 12 years.
Keywords
Acute Coronary Syndrome/mortality, Aged, Aged, 80 and over, Female, Health Facility Size, Hospital Mortality, Hospitals/classification, Humans, Inpatients, Male, Middle Aged, Outcome Assessment (Health Care), Registries, Survival, Switzerland/epidemiology
Pubmed
Web of science
Create date
29/06/2010 10:46
Last modification date
20/08/2019 14:00
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