Long-term mortality following interhospital transfer for acute myocardial infarction
Long-term mortality following interhospital transfer for acute myocardial infarction
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DOI：
10.1136/heartjnl-2014-306966
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发表时间：
2015-07-01
期刊：
影响因子：
5.7
通讯作者：
Gallagher, Martin
中科院分区：
文献类型：
--
作者：
Ranasinghe, Isuru;Barzi, Federica;Gallagher, Martin
急性心肌梗死患者入院后进行专科护理的院间转运是常见且昂贵的。然而，转移患者的长期死亡率与仅在目前医院接受治疗的患者相比，尚未进行评估。在这里，我们评估的长期死亡率进行院间转移的患者在其acute myocardial infarction accounting.Methods我们评估了40 482例ICD 10-AM诊断急性心肌梗死入院的医院在澳大利亚新南威尔士州，从2004年至2008年，其中10 107（25%）被转移。我们比较了转移和非转移患者出院后5.5年的住院和死亡率。我们创造了一个1：1倾向评分匹配队列结果在匹配队列中，转移患者更有可能接受血运重建（55.6% vs 13.7%，RR 4.05; 95% CI 3.83 - 4.29），30天时死亡率较低（3.5% vs 5.7%，HR 0.60; 95% CI 0.52 - 0.70），1年（7.5% vs 12.6%，HR 0.58; 95% CI 0.52 - 0.64）和随访结束时（15.3% vs 22.5%，HR 0.65; 95% CI 0.61 - 0.70）。除了来自有血运重建能力的医院的转移外，这些结果在一系列亚组中是一致的，包括所有年龄段的患者、ST段抬高型心肌梗死和非ST段抬高型心肌梗死患者，以及来自区域和主要城市地区的医院的转移。敏感性分析表明，这些结果是不太可能是由于生存偏倚或混杂unmeasured variables.Conclusions患者住院治疗急性心肌梗死谁是转移到一个或多个医院的专科护理有较高的冠状动脉血运重建率和经验较低的长期死亡率。
Background Interhospital transfer of patients admitted with an acute myocardial infarction for specialised care is common and costly. However, the long-term mortality of transferred patients compared with patients solely treated at the presenting hospital has not been evaluated. Here, we assess the long-term mortality of patients who undergo interhospital transfer during their acute myocardial infarction admission.Methods We evaluated 40 482 patients with a ICD10-AM diagnosis of acute myocardial infarction admitted to hospitals in New South Wales, Australia, from 2004 to 2008, of whom 10 107 (25%) were transferred. We compared in-hospital and mortality up to 5.5 years postdischarge among transferred and non-transferred patients. We created a 1: 1 propensity score matched cohort (n=16 854; 8427 per group) to account for selection bias.Results In the matched cohort, transferred patients were more likely to undergo revascularisation (55.6% vs 13.7%, RR 4.05; 95% CI 3.83 to 4.29) and had lower mortality at 30 days (3.5% vs 5.7%, HR 0.60; 95% CI 0.52 to 0.70), 1 year (7.5% vs 12.6%, HR 0.58; 95% CI 0.52 to 0.64) and at the end of follow-up (15.3% vs 22.5%, HR 0.65; 95% CI 0.61 to 0.70) than patients treated in presenting hospitals. With the exception of transfers originating from revascularisation capable hospitals, these findings were consistent across a range of subgroups, including patients of all ages, ST-elevation myocardial infarction and non ST-elevation myocardial infarction patients, and transfers originating from hospitals in regional and major city areas. Sensitivity analyses showed that these findings are unlikely to be due to survival bias or to confounding by unmeasured variables.Conclusions Patients hospitalised for an acute myocardial infarction who are transferred to one or more hospitals for specialised care have higher rates of coronary revascularisation and experience lower long-term mortality.