title: Long-term Outcomes of Patients with Acute Myocardial Infarction Presenting to Regional and Remote Hospitals.
abstract: BACKGROUND
  Acute myocardial infarction (AMI) has poorer outcomes in disadvantaged populations such as those in regional and remote locations. We compared long-term outcomes associated with presentation to regional or remote hospitals among AMI patients.
  
  
  RESULTS
  Administrative claims data from New South Wales (27% regional and remote residents) was used to identify patients >18 years admitted to any NSW hospital with a principal diagnosis of AMI (ICD10 codes: I21·0-I21·4) between 01/07/2004 and 30/06/2008. Hospital of presentation location with a population of <250,000 was defined as regional and remote while hospitals with a population >250,000 were deemed urban. Receipt of revascularisation and mortality were analysed and adjusted for age, comorbidities and previous revascularisation. Patients were censored at death or end of the follow-up period (31 December 2009). 39,798 patients were identified with 9,393 (23.6%) regional and remote presenters. In multivariable models, regional and remote presentation was associated with reduced rates of revascularisation (OR 0.30 95%CI 0.28-0.32; p<0.001), no impact on overall mortality (HR 1.04 95%CI 0.99-1.02; p=0.11), but with increased mortality for patients presenting with STEMI (HR 1.14; 95% CI 1.06-1.23; p<0.001). The propensity analysis was consistent with these findings.
  
  
  CONCLUSIONS
  Presentation to a regional and remote hospital was associated with lower revascularisation rates following AMI, but with a higher long-term mortality if presenting with ST segment elevation.
authors.affiliation: The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney Australia. Electronic address: skotwal@georgeinstitute.org.au.
authors.forename: Sradha
authors.initials: S
authors.lastname: Kotwal
authors.affiliation: The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney Australia.
authors.forename: Isuru
authors.initials: I
authors.lastname: Ranasinghe
authors.affiliation: The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Brieger
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Clayton
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.affiliation: The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Martin
authors.initials: M
authors.lastname: Gallagher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000601:surgery*; D009517:New South Wales / Q000453:epidemiology; D015996:Survival Rate
keywords: Epidemiology; Mortality; Myocardial infarction; Revascularisation; Statistics