Impact of cardiac service availability on case-selection for angiography and survival associated with angiography.
OBJECTIVE
To examine whether availability of cardiac services at the admitting hospital affects case-selection for angiography and one-year survival following angiography, within groups of patients who have similar clinical need for angiography according to published criteria.


METHODS
Elderly Medicare beneficiaries (37,788) discharged with a diagnosis of acute myocardial infarction (AMI) from hospitals in seven U.S. states between February 1994 and July 1995. We focused on patients who were eligible to receive angiography 12 or more hours after symptom onset.


METHODS
Data were abstracted from patient's medical records, Medicare National Claims Standard Analytic Files, Health Care Financing Administration (HCFA) Provider of Service File and Health Insurance Master File.


METHODS
Admitting hospitals were classified as offering no cardiac services, angiography only, or revascularization. Case-selection differences across these three types of hospitals were examined by comparing relative risk of receiving angiography for various patient and hospital characteristics. Relative differences in one-year survival rate, comparing patients who received angiography to those who did not, were estimated within each hospital type and clinical need category (necessary, appropriate, or uncertain) after matching on propensity to receive angiography.


RESULTS
Compared to patients for whom angiography was deemed necessary, the relative risk of receiving angiography among those for whom it was deemed of uncertain benefit was 0.58, 0.79, and 0.92 (p-value of homogeneity test < 0.001) at hospitals offering no cardiac services, angiography only, and revascularization, respectively. There was no significant difference in survival following angiography across hospital types, overall as well as within clinical need categories.


CONCLUSIONS
Despite increased case selection at hospitals with on-site cardiac services, there was no evidence of increase in the survival rate associated with angiography use at these hospitals.
Dendukuri
Nandini
N
Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec.
Normand
Sharon-Lise T
SL
McNeil
Barbara J
BJ
D000368:Aged; D000369:Aged, 80 and over; D016507:Cardiology Service, Hospital / Q000145:classification / Q000592:standards / Q000706:statistics & numerical data*; D017023:Coronary Angiography / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008499:Medical Records; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology; D018579:Patient Selection; D019984:Quality Indicators, Health Care; D012306:Risk; D016019:Survival Analysis; D013997:Time Factors; D014481:United States / Q000453:epidemiology