title: Contemporary inter-hospital transfer patterns for the management of acute coronary syndrome patients: findings from the EPICOR study.
abstract: OBJECTIVE
  The EPICOR observational study was designed to describe antithrombotic strategies in a broad acute coronary syndrome (ACS) population; it also included information on inter-hospital transfers and institutional resources.
  
  
  RESULTS
  EPICOR enrolled 10,568 consecutively discharged patients with ST-elevation (STE) or non-STE (NSTE) ACS in 555 centres in 20 countries across Europe and Latin America. Patients were categorized as non-transferred, transferred in from another hospital and then discharged, or transferred out to a second hospital but discharged from their initial hospital after transfer back. Two-thirds of ACS patients were non-transferred, of which only 14% were hospitalized at a centre without a catheterization laboratory, and one-third were transferred in or transferred out. Almost all transferred out patients were transferred out to a hospital with catheterization facilities, most often for primary/urgent/rescue (78%) or planned catheterization (18%) in STE myocardial infarction (STEMI), and primary/urgent/rescue (44%) or planned (43%) catheterization in NSTE-ACS. Transferred in patients were more likely to have a STEMI (60%) than non-transferred (44%) and transferred out patients (36%). In STEMI patients, time from symptom onset to catheterization was shorter in non-transferred patients (median 3.5 h vs. 5.9 h for transferred in and 6.3 h for transferred out). In NSTE-ACS, cardiac markers were positive in 66% of non-transferred patients versus 78% and 82% in transferred in and transferred out, respectively.
  
  
  CONCLUSIONS
  The lack of on-site 24/7 facilities or the availability of more advanced care are frequent reasons for inter-hospital transfer in ACS. Further follow-up of these patients will help to determine whether these practice patterns affect outcome.
authors.affiliation: University Hospitals Leuven, Belgium peter.sinnaeve@uzleuven.be.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Sinnaeve
authors.affiliation: Institut für Herzinfarktforschung Ludwigshafen, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.affiliation: Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
authors.affiliation: Hôpital Européen Georges Pompidou and René Descartes University, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.affiliation: Medical Evidence Centre AstraZeneca, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Medina
authors.affiliation: Medical Department, AstraZeneca Farmacéutica Spain, Madrid, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Sánchez-Covisa
authors.affiliation: Medical Department, AstraZeneca France, Rueil-Malmaison, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Licour
authors.affiliation: I-CHER (Interuniversity Centre for Health Economics Research) UGent, VUB, Belgium.
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
authors.affiliation: Leiden University Medical Centre, The Netherlands.
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.affiliation: London School of Hygiene and Tropical Medicine, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Pocock
authors.affiliation: University of Sheffield, UK.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Storey
authors.affiliation: University Hospitals Leuven, Belgium.
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D000368:Aged; D002404:Catheterization; D015331:Cohort Studies; D017023:Coronary Angiography; D005060:Europe / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Acute coronary syndrome; hospital; observational studies; prospective cohort study