title: Differences in treatment and outcome of patients with acute myocardial infarction admitted to hospitals with compared to without departments of cardiology; results from the pooled data of the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA 1+2) Registries and the Myocardial Infarction Registry (MIR).
abstract: OBJECTIVE
  The specialty of the admitting physician may influence treatment and outcome in patients with acute myocardial infarction.
  
  
  RESULTS
  The pooled data of three German acute myocardial infarction registries: the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) 1+2 studies and the Myocardial Infarction Registry (MIR) were analysed. Patients admitted to hospitals with departments of cardiology were compared to hospitals without such departments. A total of 24 814 acute myocardial infarction patients were included, 9020 (36%) patients at 91 (29.8%) hospitals with departments of cardiology and 15 794 (64%) at 214 (70.2%) hospitals without cardiology departments. There were only minor differences in patient characteristics and prevalence of concomitant diseases between the two types of hospital. The first electrocardiogram was more often diagnostic at hospitals with cardiology departments (71.8% vs 66.5%, P<0.001). Reperfusion therapy and adjunctive medical therapy, such as aspirin, beta-blockers and ACE-inhibitors were used more often at cardiology departments (all P -values <0.001), even after adjustment for confounding parameters. Treatment improved at both types of hospital over time. Admission to a hospital with a department of cardiology was independently associated with a lower hospital mortality (14.2% vs 15.4%, adjusted OR=0.91; 95%CI: 0.83-0.99). Additional logistic regression models showed that the higher use of reperfusion therapy and recommended concomitant medical therapy was responsible for most of the survival benefit at such hospitals.
  
  
  CONCLUSIONS
  Treatment of acute myocardial infarction patients at hospitals with departments of cardiology was independently associated with a higher use of recommended therapy and a lower hospital mortality compared to hospitals without such departments.
authors.affiliation: The Städtisches Klinikum, Nürnberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Gottwik
authors.forename: R
authors.initials: R
authors.lastname: Zahn
authors.forename: R
authors.initials: R
authors.lastname: Schiele
authors.forename: S
authors.initials: S
authors.lastname: Schneider
authors.forename: A K
authors.initials: AK
authors.lastname: Gitt
authors.forename: L
authors.initials: L
authors.lastname: Fraunberger
authors.forename: C
authors.initials: C
authors.lastname: Bossaller
authors.forename: H G
authors.initials: HG
authors.lastname: Glunz
authors.forename: E
authors.initials: E
authors.lastname: Altmann
authors.forename: W
authors.initials: W
authors.lastname: Rosahl
authors.forename: J
authors.initials: J
authors.lastname: Senges
mesh_terms: D000368:Aged; D017130:Angioplasty; D016507:Cardiology Service, Hospital; D016009:Chi-Square Distribution; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008511:Medicine; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods; D011787:Quality of Health Care; D012042:Registries; D013038:Specialization; D018709:Statistics, Nonparametric; D015912:Thrombolytic Therapy; D016896:Treatment Outcome