Are Major Medical Centers Better for Stroke and Myocardial Infarction Patients in Taiwan? A Nationwide Population-based Study

Background: Stroke and acute myocardial infarction (AMI) are serious diseases for elderly patients in Taiwan. For better outcomes, we prepared guidelines for the transfer of these patients to major medical centers. However, there has been no evidence-based research conducted in Taiwan focusing on the mortality rate of elderly AMI and stroke patients in different levels of hospital. The purpose of our study was to evaluate the outcomes for elderly stroke and AMI patients in different levels of hospitals. Methods: From the original claim data of 1 million beneficiaries enrolled in 2007, all hospitalized patients older than 50 years with the primary diagnosis of AMI, hemorrhagic stroke, or ischemic stroke (ICD-9-CM code 410, 430-432, or 433-438) were identified from the database. In 2007, 338 AMI cases, 293 hemorrhagic stroke cases, and 1,290 ischemic stroke cases were included in our study. Patients who were transferred between hospitals were excluded. All the possible risk factors such as patient age, sex, triage classification, preexisting comorbidities, and different hospital levels were adjusted for in a logistic regression model. Results: In ischemic stroke patients, the odds ratio of mortality for the patients in major medical centers was 0.4 times that for patients in regional hospitals. Thus, major medical centers were safer for ischemic stroke patients after adjusting for patient age, sex, triage classifications and preexisting comorbidities. However, differences in the survival rates of hemorrhagic stroke patients between hospitals were insignificant. In AMI patients, the survival rates were also not significantly different after adjusting for age, sex, triage classification, preexisting comorbidities and hospital level. Conclusions: Our study showed that major medical centers were safer only for ischemic stroke patients after adjusting for patient age, sex, triage classifications and preexisting comorbidities. This finding suggests that all patients with acute onset stroke should be sent to major medical centers for further evaluation and treatment.