Transfer of acutely ill cardiac patients for definitive care. Demonstrated safety in 755 cases

The safety of transporting acutely ill cardiac patients for cardiac catheterization has not been established. We describe 755 consecutive patients sent by ambulance from community hospitals to a tertiary center during an 18-month period. Eighty-seven percent of the patients were class III or IV New York Heart Association classification for angina. At catheterization, left ventricular dysfunction (ejection fraction less than 55%) was present in 40%. Forty-three percent of patients required urgent intervention (coronary artery bypass surgery or percutaneous transluminal coronary angioplasty). The patients were transported by paramedic ambulance up to 99 km (less than or equal to 62 miles) without a physician in attendance. No complications occurred in patients transferred within our guidelines. We believe that seriously ill cardiac patients can be transferred safely for definitive care. A single tertiary center providing immediate access to catheterization and surgical facilities can service a large population and many community hospitals.