title: Outcome of patients with acute coronary syndrome in hospitals of different sizes. A report from the AMIS Plus Registry.
abstract: OBJECTIVE
  To assess the impact of admission to different hospital types on early and 1-year outcomes in patients with acute coronary syndrome (ACS).
  
  
  METHODS
  Between 1997 and 2009, 31 010 ACS patients from 76 Swiss hospitals were enrolled in the AMIS Plus registry. Large tertiary institutions with continuous (24 hour/7 day) cardiac catheterisation facilities were classified as type A hospitals, and all others as type B. For 1-year outcomes, a subgroup of patients admitted after 2005 were studied.
  
  
  RESULTS
  Eleven type A hospitals admitted 15987 (52%) patients and 65 type B hospitals 15023 (48%) patients. Patients admitted into B hospitals were older, more frequently female, diabetic, hypertensive, had more severe comorbidities and more frequent non-ST segment elevation (NSTE)-ACS/unstable angina (UA). STE-ACS patients admitted into B hospitals received more thrombolysis, but less percutaneous coronary intervention (PCI). Crude in-hospital mortality and major adverse cardiac events (MACE) were higher in patients from B hospitals. Crude 1-year mortality of 3747 ACS patients followed up was higher in patients admitted into B hospitals, but no differences were found for MACE. After adjustment for age, risk factors, type of ACS and comorbidities, hospital type was not an independent predictor of in-hospital mortality, in-hospital MACE, 1-year MACE or mortality. Admission indicated a crude outcome in favour of hospitalisation during duty-hours while 1-year outcome could not document a significant effect.
  
  
  CONCLUSIONS
  ACS patients admitted to smaller regional Swiss hospitals were older, had more severe comorbidities, more NSTE-ACS and received less intensive treatment compared with the patients initially admitted to large tertiary institutions. However, hospital type was not an independent predictor of early and mid-term outcomes in these patients. Furthermore, our data suggest that Swiss hospitals have been functioning as an efficient network for the past 12 years.
authors.affiliation: AMIS Plus Data Center, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland. dragana@ifspm.uzh.ch
authors.forename: Dragana
authors.initials: D
authors.lastname: Radovanovic
authors.forename: Philip
authors.initials: P
authors.lastname: Urban
authors.forename: René
authors.initials: R
authors.lastname: Simon
authors.forename: Markus
authors.initials: M
authors.lastname: Schmidli
authors.forename: Marco
authors.initials: M
authors.lastname: Maggiorini
authors.forename: Hans
authors.initials: H
authors.lastname: Rickli
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Stauffer
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: Felix
authors.initials: F
authors.lastname: Gutzwiller
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006276:Health Facility Size; D017052:Hospital Mortality; D006761:Hospitals / Q000145:classification*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012042:Registries; D013534:Survival; D013557:Switzerland / Q000453:epidemiology