Key result
Coronary care units in small community hospitals had a 14.5% crude mortality rate for acute myocardial infarction, not statistically different from the 11.5% rate in larger comparison hospitals.
Why the study?
Does admission to coronary care units in small community hospitals improve mortality in patients with acute myocardial infarction compared to larger hospitals?
Cohort
Yes
Does admission to coronary care units in small community hospitals improve mortality in patients with acute myocardial infarction compared to larger hospitals?
Absolute Event Rate: 14.5% vs 11.5%
Coronary care units in small community hospitals can provide adequate care for acute myocardial infarction, but mortality increases significantly in units with low patient volume (<60 infarctions per year).
Comparable mortality supports small-hospital CCUs for AMI; leaves open volume thresholds for optimal outcomes.
A prospective study was undertaken from 1969 to 1974 to evaluate a program establishing coronary care units in small community hospitals. Crude mortality rates from acute myocardial infarction in these small hospitals were 14.5%, slightly higher but not statistically different from concurrently collected data in three larger comparision hospitals (11.5%). Mutivariate discriminate analysis of clinical characteristics was used to calculate a risk score for each patient admitted. Observed deaths exceeded expected deaths (134 versus 119) (P greater than 0.30) in small hospitals but observed deaths were less than expected (55 versus 77)(P less than 0.05) in comparison hospitals. Mortality was significantly greater in those units admitting fewer than 60 patients with infarctions yearly (20.9%) than in those admitting more than 60 (10.7%) (P less than 0.001). These data suggest that coronary care units in small community hospitals can provide adequate coronary care, but their level of performance drops when fewer than 60 patients with infarctions are admitted yearly.
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Jeoffrey K. Stross (1976) conducted a cohort in Acute myocardial infarction. Coronary care units in small community hospitals vs. Larger comparison hospitals was evaluated on Crude mortality. Coronary care units in small community hospitals had a 14.5% crude mortality rate for acute myocardial infarction, not statistically different from the 11.5% rate in larger comparison hospitals.
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