Quality of Care for Myocardial Infarction at Academic and Nonacademic Hospitals

被引：14

作者：

Belle, Loic ^{[2
]}

Labarere, Jose ^{[1
,3
]}

Fourny, Magali ^{[1
]}

Drouet, Elodie ^{[4
]}

Mulak, Genevieve ^{[5
]}

Dujardin, Jean-Jacques

Vilarem, Didier ^{[6
]}

Bonnet, Philippe ^{[7
]}

Hanssen, Michel

Simon, Tabassome ^{[4
,8
]}

Ferrieres, Jean ^{[9
,10
]}

Danchin, Nicolas ^{[11
,12
]}

机构：

[1] Grenoble Univ Hosp, Qual Care Unit, F-38043 Grenoble 9, France

[2] Annecy Gen Hosp, Dept Cardiol, Annecy, France

[3] Univ Grenoble 1, CNRS, UMR 5525, TIMC, F-38041 Grenoble, France

[4] St Antoine Hosp, AP HP, URC EST, St Antoine, France

[5] Soc Francaise Cardiol, Paris, France

[6] Valenciennes Gen Hosp, Dept Cardiol, Valence, France

[7] Le Havre Gen Hosp, Dept Cardiol, Le Havre, France

[8] Univ Paris 06, F-75252 Paris 05, France

[9] Toulouse Univ Hosp, Dept Cardiol, Toulouse, France

[10] Univ Toulouse 3, INSERM, UMR 558, F-31062 Toulouse, France

[11] Hop Europeen Georges Pompidou, AP HP, Div Coronary Artery Dis & Intens Cardiac Care, Pompidou, France

[12] Univ Paris 05, F-75270 Paris 06, France

来源：

AMERICAN JOURNAL OF MEDICINE | 2012年 / 125卷 / 04期

关键词：

Academic medical centers; Mortality; Myocardial infarction; Quality of health care; ST-SEGMENT-ELEVATION; PERCUTANEOUS CORONARY INTERVENTION; NONTEACHING HOSPITALS; TEACHING HOSPITALS; NATIONAL REGISTRY; PATIENT OUTCOMES; FRENCH REGISTRY; FAST-MI; MORTALITY; REPERFUSION;

D O I：

10.1016/j.amjmed.2011.11.015

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: Whether academic hospitals provide better quality of care for patients with acute myocardial infarction is widely debated. The aim of this study was to compare processes of care and mortality between academic and nonacademic hospitals in the contemporary era of acute myocardial infarction management. METHODS: We analyzed the original data from a prospective cohort study of 3059 patients, including 1714 with ST-segment elevation and 1345 with non-ST-segment elevation myocardial infarction, enrolled at 39 and 183 academic and nonacademic hospitals, respectively, in France. RESULTS: Unadjusted 1-year mortality for academic and nonacademic hospitals was 10% versus 15% for patients with ST-segment elevation myocardial infarction (P = .01) and 13% versus 14% for patients with non-ST-segment elevation myocardial infarction (P = .75). Patients treated in academic or nonacademic hospitals with percutaneous coronary intervention capability were more likely to receive reperfusion and recommended drug therapies than those treated in nonacademic hospitals without percutaneous coronary intervention capability. After adjusting for baseline characteristics, the hazards of death associated with admission to nonacademic hospitals with and without percutaneous coronary intervention capability relative to academic hospitals were 1.13 (95% confidence interval [CI], 0.79-1.62) and 1.65 (95% CI, 1.09-2.49) for those with ST-segment elevation myocardial infarction and 0.95 (95% CI, 0.66-1.36) and 1.06 (95% CI, 0.72-1.58) for those with non-ST-segment elevation myocardial infarction, respectively. Further adjustment for receipt of acute reperfusion and recommended drug therapies eliminated all differences in mortality between the study groups. CONCLUSION: Admission to academic hospitals was associated with a more frequent use of recommended therapies, conveying a survival advantage for patients with ST-segment elevation myocardial infarction. (C) 2012 Elsevier Inc. All rights reserved. The American Journal of Medicine (2012) 125, 365-373

引用

页码：365 / 373

页数：9

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