The region makes the difference: disparities in management of acute myocardial infarction within Switzerland
The region makes the difference: disparities in management of acute myocardial infarction within Switzerland
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DOI：
10.1177/2047487312469122
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发表时间：
2014-05-01
影响因子：
8.3
通讯作者：
Marques-Vidal, Pedro
中科院分区：
文献类型：
--
作者：
Insam, Charlene;Paccaud, Fred;Marques-Vidal, Pedro
背景在瑞士，卫生政策由地方一级决定，但对它们对急性心肌梗死（AMI）管理的影响知之甚少。在这项研究中，我们评估了瑞士AMI管理的地理差异。设计横断面研究。方法2007-2008年期间瑞士医院出院数据库（26，204例AMI出院）。分析了瑞士的七个地区（莱曼、米特兰、西北、苏黎世、中部、东部和蒂奇诺）。结果近53.7%的AMI出院患者由一家医院管理，范围从62.1%（莱曼）到31.6%（蒂奇诺）。重症监护室入院率最高的是莱曼（69.4%），最低的是蒂奇诺（16.9%）（瑞士平均水平：36.0%）。Leman的冠状动脉内血运重建率最高（51.1%），瑞士中部最低（30.9%）（平均：41.0%）。裸（非药物洗脱）支架使用率在Leman最高（61.4%），在蒂奇诺最低（16.9%）（平均：42.1%），而药物洗脱支架使用率在蒂奇诺最高（83.2%），在Leman最低（38.6%）（平均：57.9%）。蒂奇诺的冠状动脉旁路移植率最高（4.8%），瑞士东部最低（0.5%）（平均2.8%）。苏黎世的机械循环辅助率最高（4.2%），蒂奇诺最低（0.5%）（平均1.8%）。在调整了年龄、单一或多个医院管理和性别后，差异仍然存在。结论：在瑞士，AMI的管理和血运重建程序存在显著的地理差异。
Background In Switzerland, health policies are decided at the local level, but little is known regarding their impact on the management of acute myocardial infarction (AMI). In this study, we assessed geographical differences within Switzerland regarding management of AMI. Design Cross-sectional study. Methods Swiss hospital discharge database for period 2007-2008 (26,204 discharges from AMI). Seven Swiss regions (Leman, Mittelland, Northwest, Zurich, Central, Eastern, and Ticino) were analysed. Results Almost 53.7% of discharges from AMI were managed in a single hospital, ranging from 62.1% (Leman) to 31.6% (Ticino). The highest intensive care unit admission rate was in Leman (69.4%), the lowest (16.9%) in Ticino (Swiss average: 36.0%). Intracoronary revascularization rates were highest in Leman (51.1%) and lowest (30.9%) in Central Switzerland (average: 41.0%). Bare (non-drug-eluting) stent use was highest in Leman (61.4%) and lowest (16.9%) in Ticino (average: 42.1%), while drug-eluting stent use was highest (83.2%) in Ticino and lowest (38.6%) in Leman (average: 57.9%). Coronary artery bypass graft rates were highest (4.8%) in Ticino and lowest (0.5%) in Eastern Switzerland (average: 2.8%). Mechanical circulatory assistance rates were highest (4.2%) in Zurich and lowest (0.5%) in Ticino (average: 1.8%). The differences remained after adjusting for age, single or multiple hospital management, and gender. Conclusions In Switzerland, significant geographical differences in management and revascularization procedures for AMI were found.