The association between hospital department, medical treatment and outcome in acute myocardial infarction.
BACKGROUND
Although the preferred management of a patient presenting with an acute myocardial infarction is in a coronary care unit, data based on discharge diagnoses in Israel indicate that many of these patients are treated outside of such units.


OBJECTIVE
To compare the demographic and clinical characteristics, treatment and mortality of AMI patients treated inside and outside a CCU.


METHODS
We compiled a registry of all patients admitted to three general hospitals in Haifa, Israel during January, March, May, July, September and November 1996.


RESULTS
The non-CCU admission rate was 22%. CCU patients were younger (61.6 vs. 65.5 years), less likely to report a past AMI (18% vs. 34%), and arrived earlier at the emergency room. Non-CCU patients were more likely to present with severe heart failure (30 vs. 11%). Non-CCU patients received less aspirin (81 vs. 95%) and betablockers (62 vs. 80%). Upon discharge, these patients were less frequently prescribed beta-blockers and cardiac rehabilitation programs. CCU-treated patients had lower unadjusted mortality rates at both 30 days (odds ratio = 0.35) and in the long term (hazards ratio = 0.57). These ratios were attenuated after controlling for gender, age, type of AMI, and degree of heart failure (OR = 0.91 and HR = 0.78, respectively).


CONCLUSIONS
A relatively high proportion of AMI patients were treated outside a CCU, with older and sicker patients being denied admission to a CCU. The process of evidence-based care by cardiologists was preferable to that of internists both during the hospital stay and at discharge. In Israel a significant proportion of all AMI admissions are initially treated outside a CCU. Emphasis on increasing awareness in internal medicine departments to evidence-based care of AMI is indicated.
D000368:Aged; D002309:Cardiology / Q000592:standards; D003325:Coronary Care Units / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006748:Hospital Departments / Q000592:standards / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007388:Internal Medicine / Q000592:standards; D007557:Israel / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models