Interhospital transfer of Medicare patients with acute myocardial infarction was associated with a lower 30-day mortality compared to non-transferred patients (OR 0.80).
Observational (n=184,295)
Yes
Does interhospital transfer improve 30-day mortality in Medicare patients with acute myocardial infarction?
Interhospital transfer of Medicare patients with acute myocardial infarction is associated with lower 30-day mortality, even after rigorous propensity score matching to account for baseline differences.
Effect estimate: OR 0.80 (95% CI 0.76-0.84)
Absolute Event Rate: 10.7% vs 12.5%
p-value: p=<0.001
BACKGROUND: Many patients suffering acute myocardial infarction (AMI) are transferred from one hospital to another during their hospitalization. There is little information about the outcomes related to interhospital transfer. The purpose of this study was to compare processes and outcomes of AMI care among patients undergoing interhospital transfer with special attention to the impact on mortality in rural hospitals. METHODS: National sample of Medicare patients in the Cooperative Cardiovascular Study (n = 184,295). Retrospective structured medical record review of AMI hospitalizations. Descriptive study using a retrospective propensity score analysis of clinical and administrative data for 184,295 Medicare patients admitted with clinically confirmed AMI to 4,765 hospitals between February 1994 and July 1995. Main outcome measure included: 30-day mortality, administration of aspirin, beta-blockers, ACE-inhibitors, and thrombolytic therapy. RESULTS: Overall, 51,530 (28%) patients underwent interhospital transfer. Transferred patients were significantly younger, less critically ill, and had lower comorbidity than non-transferred patients. After propensity-matching, patients who underwent interhospital transfer had better quality of care anlower mortality than non-transferred patients. Patients cared for in a rural hospital had similar mortality as patients cared for in an urban hospital. CONCLUSION: Transferred patients were vastly different than non-transferred patients. However, even after a rigorous propensity-score analysis, transferred patients had lower mortality than non-transferred patients. Mortality was similar in rural and urban hospitals. Identifying patients who derive the greatest benefit from transfer may help physicians faced with the complex decision of whether to transfer a patient suffering an acute MI.
Westfall et al. (Tue,) conducted a observational in Acute myocardial infarction (n=184,295). Interhospital transfer vs. Non-transferred was evaluated on 30-day mortality (OR 0.80, 95% CI 0.76-0.84, p=<0.001). Interhospital transfer of Medicare patients with acute myocardial infarction was associated with a lower 30-day mortality compared to non-transferred patients (OR 0.80).