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Patients with chest pain are typically taken by ambulance to the nearest hospital approved to take emergency cases; but your patients are getting the message through the popular press that the hospital closest to their home (or closest to the site of their infarction) may not be the best place to go if they have a heart attack.
Media sources such as The New York Times had front-page stories in late May announcing findings of Johns Hopkins University investigators who compared 30-day and one-year mortality rates of 100,000 infarction patients who were treated at 4,000 hospitals — high-volume and low-volume facilities closest to their homes.1
After investigators adjusted for differences in severity, the patients treated at the lowest-volume hospitals were 17% more likely to die within 30 days after admission than those treated at the highest-volume hospitals. High-volume hospitals were those that averaged at least 4.4 heart attack patients a week; low-volume sites treated 1.4 or fewer. Also, the investigators found that the use of aspirin, beta-blockers, and other treatments accounted for about one-third of the survival benefit at the high-volume hospitals. The rest is chalked up to the experience of doctors, nursing staff, and technicians.
1. Thiemann DR, Coresh J, Oetgen WJ, et al. The association between hospital volume and survival after acute myocardial infarction in elderly patients. N Engl J Med 1999; 340:1,640-1,648.