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  • Title: Community hospital versus tertiary hospital comparison in the treatment and outcome of patients with acute coronary syndrome: a New Zealand experience.
    Author: Tang EW, Wong CK, Herbison P.
    Journal: N Z Med J; 2006 Jul 21; 119(1238):U2078. PubMed ID: 16868575.
    Abstract:
    AIMS: To compare the baseline characteristics, use of evidence-based medications, rate of revascularisation, and mortality of acute coronary syndrome (ACS) patients managed in a community hospital (Invercargill Hospital) without, and a tertiary teaching hospital (Dunedin Hospital) with, catheterisation and an interventional facility. METHODS: All patients with ACS admitted into Dunedin and Invercargill coronary care units (CCUs) between 2000-2002 inclusive were included in the study. RESULTS: Major baseline characteristics including age, history of diabetes, heart rate and systolic blood pressure at presentation were not different between the two centres. However, the proportions of patients with ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI) were higher in Invercargill CCU. More Invercargill patients experienced a cardiac arrest or clinical heart failure on hospital arrival. The use of evidence-based medications, coronary angiography (65.5% vs 20.2%, p<0.00001), and revascularisation (46.7% vs 16.4%, p<0.0005) were significantly higher in patients admitted into Dunedin CCU. The in-hospital, 6-months, and 1-year mortality was significantly lower (absolute mortality difference of 4.3%, 9.5%, and 10.0%, p<0.05, respectively) for ACS patients admitted into Dunedin CCU. Using multivariable logistic regression incorporating baseline characteristics, use of evidence-based medicine on arrival and transfer for angiography, the 1-year adjusted hazard ratio 3.02 (95%CI 1.60-5.71) remains significantly higher for patients in Invercargill Hospital. CONCLUSION: There was a disparity in ACS outcome between community and tertiary hospitals in New Zealand. The use of evidence-based medicine in all ACS patients should be encouraged even if revascularisation was not offered.
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