title: The region makes the difference: disparities in management of acute myocardial infarction within Switzerland.
abstract: BACKGROUND
  In Switzerland, health policies are decided at the local level, but little is known regarding their impact on the management of acute myocardial infarction (AMI). In this study, we assessed geographical differences within Switzerland regarding management of AMI.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Swiss hospital discharge database for period 2007-2008 (26,204 discharges from AMI). Seven Swiss regions (Leman, Mittelland, Northwest, Zurich, Central, Eastern, and Ticino) were analysed.
  
  
  RESULTS
  Almost 53.7% of discharges from AMI were managed in a single hospital, ranging from 62.1% (Leman) to 31.6% (Ticino). The highest intensive care unit admission rate was in Leman (69.4%), the lowest (16.9%) in Ticino (Swiss average: 36.0%). Intracoronary revascularization rates were highest in Leman (51.1%) and lowest (30.9%) in Central Switzerland (average: 41.0%). Bare (non-drug-eluting) stent use was highest in Leman (61.4%) and lowest (16.9%) in Ticino (average: 42.1%), while drug-eluting stent use was highest (83.2%) in Ticino and lowest (38.6%) in Leman (average: 57.9%). Coronary artery bypass graft rates were highest (4.8%) in Ticino and lowest (0.5%) in Eastern Switzerland (average: 2.8%). Mechanical circulatory assistance rates were highest (4.2%) in Zurich and lowest (0.5%) in Ticino (average: 1.8%). The differences remained after adjusting for age, single or multiple hospital management, and gender.
  
  
  CONCLUSIONS
  In Switzerland, significant geographical differences in management and revascularization procedures for AMI were found.
authors.affiliation: Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Charlène
authors.initials: C
authors.lastname: Insam
authors.forename: Fred
authors.initials: F
authors.lastname: Paccaud
authors.forename: Pedro
authors.initials: P
authors.lastname: Marques-Vidal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities / Q000639:trends*; D006353:Heart-Assist Devices / Q000639:trends; D017052:Hospital Mortality; D006760:Hospitalization / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000639:trends*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D016016:Proportional Hazards Models; D012111:Residence Characteristics; D015607:Stents / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome