Long-term morbidity in patients with acute chest pain. A comparison between a city university hospital and a county hospital.
OBJECTIVE
To compare long-term morbidity after hospital discharge in patients admitted to the emergency department with acute chest pain in a city university hospital and a county hospital.


METHODS
Patients with acute chest pain admitted to the emergency department due to acute chest pain at Sahlgrenska University Hospital in Göteborg, Sweden, and at Uddevalla County Hospital in Uddevalla, Sweden, between October 21, 1996, and April 30, 1997, were retrospectively followed for 30 months.


RESULTS
The mortality during the subsequent 30 months was similar in the two cohorts (16% in the city university hospital and 15% in the county hospital, respectively). In the city university hospital 1575 patients and in the county hospital 715 patients took part in the evaluation of survivors. Coronary angiography was performed less frequently in patients in the city hospital (14% versus 20%; p = 0.002) but there was no difference with regard to development of myocardial infarction (6% versus 7%), stroke (2% in both cohorts) or requirement of percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) after hospital discharge. The proportion of patients who were rehospitalized did not differ, but the mean number of days in hospital per patient and per hospitalized patient was higher in the county hospital (10.2 +/- 17.2 versus 6.7 +/- 13.7 (p = 0.0003) and 17.3 +/- 19.5 versus 13.2 +/- 16.8 (p = 0.003), respectively). P-values were adjusted for differences in the patient's characteristics. The proportion of patients rehospitalized due to stable angina pectoris, cardiac arrhythmias and heart investigation was higher in the county hospital.


CONCLUSIONS
In chest pain patients admitted to a city university hospital and a county hospital morbidity differences were found after hospital discharge indicating a higher requirement of rehospitalization for various cardiac reasons and a higher use of coronary angiography in the county hospital after discharge from hospital. The mechanisms behind this observation are not clear at present.
Karlson
Björn W
BW
Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Kalin
Björn
B
Karlsson
Thomas
T
Stensdotter
Lillemor
L
Zehlertz
Elisabeth
E
Herlitz
Johan
J
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000150:complications / Q000401:mortality / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006766:Hospitals, County; D006785:Hospitals, University; D006786:Hospitals, Urban; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology