Use of medical resources, complications and long-term outcome in patients hospitalized with acute chest pain. A comparison between a city university hospital and a county hospital.
OBJECTIVE
The primary aim was to test the hypothesis that there is a difference in long-term outcome after hospital discharge among patients hospitalized with acute chest pain in a university hospital and a county hospital. Secondary aims were to compare these two hospitals with regard to use of medical resources, occurrence of complications and risk indicators for death.


METHODS
All patients hospitalized at Sahlgrenska University Hospital in Göteborg (with a catchment population of 706 inhabitants/km(2)) and Uddevalla County Hospital (with a catchment population of 34 inhabitants/km(2)) due to symptoms of acute chest pain during a period of 6 months.


RESULTS
Complications, use of medical resources and mortality during the subsequent 2 years after discharge were compared among 1,592 hospitalizations in a city hospital and 822 in a county hospital due to acute chest pain. Angina pectoris after the first event, congestive heart failure and various arrhythmias were more frequently reported in the county hospital. The use of medical resources differed. Thus, the use of betablockers, heparin, antiarrhythmics, diuretics and nipride was more frequent in the county hospital, whereas the use of nitrates, digitalis, coronary angiography, percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) was more frequent in the city hospital. Despite these differences, the mortality 2 years after hospital discharge was similar (14.7% in the city hospital and 12.8% in the county hospital, P=0.26). Two factors, intravenous digitalis in hospital and a prescription of insulin at discharge, were significantly more associated with death in the county hospital compared with the city hospital.


CONCLUSIONS
When comparing a city university hospital with a county hospital with regard to patients admitted with chest pain, major differences in terms of complications and use of medical resources were found. Thus, various complications were reported more frequently in the county hospital. The use of medical resources varied, some being used more frequently in the county hospital, whereas others were used more frequently in the university hospital. Despite these differences the mortality 2 years after hospital discharge was similar in the two cohorts.
Karlson
Björn W
BW
Division of Cardiology, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden.
Kalin
Björn
B
Karlsson
Thomas
T
Svensson
Lillemor
L
Zehlertz
Elisabeth
E
Herlitz
Johan
J
D000208:Acute Disease; D000368:Aged; D000704:Analysis of Variance; D000787:Angina Pectoris / Q000150:complications / Q000401:mortality / Q000628:therapy; D002637:Chest Pain / Q000150:complications / Q000401:mortality / Q000628:therapy; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006766:Hospitals, County / Q000592:standards / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000592:standards / Q000706:statistics & numerical data; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D013223:Statistics as Topic; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome