Admission to Hospitals With On-Site Cardiac Catheterization Facilities

Abstract

Background-Admission to a hospital with a capability for cardiac procedures is associated with a higher likelihood of referral for a cardiac procedure but not with a better short-term clinical outcome. Whether there are differences in long-term mortality and resource consumption is not clear. We sought to determine whether elderly Medicare patients with acute myocardial infarction admitted to hospitals with on-site cardiac catheterization facilities have lower long-term hospital costs and better outcomes than patients admitted to hospitals without such facilities. Methods and Results-As part of the Cooperative Cardiovascular Project pilot in Connecticut, we conducted a retrospective cohort study using data from medical charts and administrative files. The study sample included 2521 patients with acute myocardial infarction covered by Medicare from 1992 to 1993. The cardiac catheterization rate was higher in the hospitals with facilities (38.6% versus 26.9%; PϽ0.001), but the revascularization rate was similar (20.5% versus 19.5%) during the initial episode of care and at 3 years (29.7% versus 29.7%). Mortality rates were similar for patients admitted to the 2 types of hospitals at 30 days (OR, 1.08; 95% CI, 0.83 to 1.42) and at 3 years (OR, 1.02; 95% CI, 0.83 to 1.26). The adjusted readmission rates were significantly lower among patients admitted to hospitals with cardiac catheterization facilities (OR, 0.76; 95% CI, 0.61 to 0.94). However, the overall mean days in the hospital for the 3 years after admission was 25.9 for patients admitted to hospitals with facilities and 24.6 for the other patients (Pϭ0.234). Adjusting for baseline patient characteristics, there was no significant difference in the 3-year costs between patients admitted to the 2 types of hospitals. Conclusions-With higher rates of cardiac catheterization and lower readmission rates, patients admitted to hospitals with on-site cardiac catheterization facilities did not have significantly different hospital costs compared with patients admitted to hospitals without these facilities. There was also no significant difference in short-or long-term mortality rates.

Temporal Trends in Cardiogenic Shock Treatment and Outcomes Among Ontario Patients With Myocardial Infarction Between 1992 and 2008

“…[15][16][17] It was previously reported that AMI patients admitted to revascularization-capable sites are more frequently revascularized with modest or no survival advantage. 9,18,19 The SHOCK trial, however, demonstrated that AMI patients with CS who were randomly assigned to emergency revascularization had an absolute risk reduction of 12.8% in 6-month mortality rate. 2 Yet, the impact of admission hospital type on survival remains unknown in this setting.…”

Payments for Acute Myocardial Infarction Episodes-of-Care Initiated at Hospitals With and Without Interventional Capabilities

“…8 The study by Krumholz et al 8,9 found no significant difference in hospital costs during the 3 years after the initial admission for patients admitted to hospitals with and without cardiac catheterization capability. Despite similar findings, the study variables differed substantially from those used in this study.…”

“…1 This increase in the number of PCI hospitals could have implications for both the quality and cost of care for patients with AMI. Although several recent studies have examined whether increased PCI capability improves access or outcomes, [1][2][3][4][5][6][7][8] little is known about the cost of treatment for patients admitted with AMI at PCI hospitals versus non-PCI hospitals. This group has previously found that hospital costs for patients admitted to facilities with and without catheterization capabilities did not differ substantially.…”

“…This group has previously found that hospital costs for patients admitted to facilities with and without catheterization capabilities did not differ substantially. 8 However, this work was done for patients admitted between 1992 and 1993 in a single state; to our knowledge, there have been no recent comparisons of hospital costs for patients with AMI admitted to PCI versus non-PCI facilities and no such studies done on a national level.…”

Methods for Handling Inter-Hospital Transfer in acute Myocardial Infarction Research

“…32 The Connecticut substudy of the CCP linked transfers between hospitals to study the impact of on-site catheterization. 33 They linked data for 3 years and found little difference in cost and mortality between hospitals with and without on-site catheterization.…”