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  • Title: Survival over 5 years in the initial hospital survivors with acute coronary syndrome: a comparison between a community hospital and a tertiary hospital in New Zealand.
    Author: Wong CK, Tang EW, Herbison P.
    Journal: N Z Med J; 2007 Sep 07; 120(1261):U2713. PubMed ID: 17853934.
    Abstract:
    AIMS: To compare the outcome of hospital survivors with acute coronary syndrome (ACS) discharged from a community hospital (Invercargill hospital) versus from a tertiary teaching (Dunedin) hospital followed for up to 5 years. METHODS: All ACS survivors discharged from Dunedin and Invercargill coronary care units between the years 2000-2002 were included. We previously found higher 1-year mortality for Invercargill patients but the explanation was unclear. RESULTS: Of the 844 patients admitted to Dunedin and 299 admitted to Invercargill hospital, 1057 survived the index ACS episode and formed the cohort for the current study. At 2 years, the mortality of these initial survivors was 8.5% higher for Invercargill patients (18.4% vs 9.9%, p<0.001). Over up to 5 years of follow-up, comparing Invercargill patients to Dunedin patients, the unadjusted hazard ratio for mortality was 1.26 (95%CI: 0.90-1.75). After adjusting to the hospital discharge GRACE score (119+/-40 for Dunedin patients and 130+/-40 for Invercargill patients, p=0.001), this dropped to 1.12 (95%CI: 0.80-1.57). After further adjusting to the discharge medications aspirin (97% vs 98%) and ACE-inhibitors (53% vs 49%), this was 1.14 (95%CI 0.81-1.59). After further adjusting to the use of beta-blockers (78% vs 71%), this was 1.07 (95%CI: 0.76-1.50). After final adjustment for the use of statins (65% vs 42%), this was 0.96 (95%CI: 0.68-1.36). CONCLUSION: Patients discharged from Invercargill hospital fare worse over the first 2-years and tended to fare worse over the first 5-years. This was due both to their higher baseline risk at discharge and the under-use of statins. Of note, PHARMAC rules for statins only changed around the end of the study period allowing more liberal use of statins.
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