Audit of a collaborative care model suggests patients with acute myocardial infarction are not disadvantaged by treatment in a rural hospital.
OBJECTIVE
Recent data suggest that improvements in survival post myocardial infarction in urban hospitals have not been matched by rural hospitals. We performed an audit of a collaborative model of care between a rural hospital and its base hospital to see if this was also the case in a rural area of New Zealand, and attempted to identify reasons underlying any discrepancy, should it exist.


METHODS
The medical records of all patients with a discharge diagnosis of acute myocardial infarction (AMI) over a five-year period were reviewed and data on management, medication and outcomes collected.


RESULTS
196 patients with confirmed AMI were treated from 1995-1999. There was a documented consultation with a cardiologist in 54% of cases. Seventy one per cent of patients were managed and discharged from the rural hospital, while 23% were subsequently transferred to base hospital. The in-hospital, 30-day and one-year cardiovascular mortality rates were 5.6%, 7.7% and 13.5% respectively.


CONCLUSIONS
These figures compare favourably with those previously published in NZ and internationally, suggesting that rural hospitals can achieve similar outcomes to larger centres when working in close collaboration with base hospital specialists.
Fearnley
David
D
Dunstan Hospital, Clyde, New Zealand.
McLean
Jan
J
Wilkins
Gerard
G
Restieaux
Norma
N
Nixon
Garry
G
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006780:Hospitals, Rural / Q000592:standards*; D006786:Hospitals, Urban / Q000592:standards*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D009520:New Zealand / Q000453:epidemiology; D012423:Rural Health / Q000592:standards; D015996:Survival Rate; D014504:Urban Health / Q000592:standards