In-hospital mortality due to acute myocardial infarction. relevance of type of hospital and care provided. RECALCAR study.
OBJECTIVE
To investigate the relationship between in-hospital mortality due to acute myocardial infarction and type of hospital, discharge service, and treatment provided.


METHODS
Retrospective analysis of 100 993 hospital discharges with a principal diagnosis of myocardial infarction in hospitals of the Spanish National Health Service. In-hospital mortality was adjusted for risk following the models of the Institute for Clinical Evaluative Sciences (Canada) and the Centers for Medicare & Medicaid Services (United States).


RESULTS
Hospital characteristics are relevant to explain the variation in the individual probability of dying from myocardial infarction (median odds ratio: 1.3561). The risk-adjusted in-hospital mortality in cluster 3 and especially in cluster 4 hospitals (500 beds to 1000 beds and medium-high complexity) was significantly lower than in hospitals with less than 200 beds. Cluster 5 (more than 1000 beds), which includes a diverse group of hospitals, had a higher mortality rate than clusters 3 and 4. The adjusted mortality in the groups with the best and worst outcomes was 6.74% (cluster 4) and 8.49% (cluster 1), respectively. Mortality was also lower when the cardiology unit was responsible for the discharge or when angioplasty had been performed.


CONCLUSIONS
The typology of the hospital, treatment in a cardiology unit, and percutaneous coronary intervention are significantly associated with the survival of a patient hospitalized for myocardial infarction. We recommend that the Spanish National Health Service establish health care networks that favor percutaneous coronary intervention and the participation of cardiology units in the management of patients with acute myocardial infarction.
Servicio de Cardiología, Hospital San Juan, Universidad Miguel Hernández, Alicante, Spain.
Vicente
V
Bertomeu
Àrea de Malalties del Cor, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
Ángel
Á
Cequier
Control de Gestión, Hospital 12 de Octubre, Madrid, Spain.
José L
JL
Bernal
Departamento de Cardiología Intervencionista, Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Fernando
F
Alfonso
Servicio de Cardiología, Hospital Reina Sofía, Córdoba, Spain.
Manuel P
MP
Anguita
Instituto de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain.
Javier
J
Muñiz
Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
José A
JA
Barrabés
Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
David
D
García-Dorado
Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain.
Javier
J
Goicolea
Elola Consultores, Madrid, Spain. Electronic address: fjelola@elolaconsultores.com.
Francisco J
FJ
Elola
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality; D002423:Cause of Death; D016009:Chi-Square Distribution; D016000:Cluster Analysis; D015331:Cohort Studies; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy; D011787:Quality of Health Care; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013030:Spain; D016019:Survival Analysis; D016896:Treatment Outcome
AMI; Angioplastia; Coronary angioplasty; Hospital organization; In-hospital mortality; Infarto de miocardio; Intervencionismo coronario percutáneo; Mortalidad intrahospitalaria; Myocardial infarction; NHS; National Health Service; Organización hospitalaria; Percutaneous coronary intervention; RSMR; Reperfusion; Reperfusión; acute myocardial infarction; risk-standardized mortality ratio