Community hospitals do not transfer high-risk heart patients for aggressive therapy

NEW ORLEANS -- In an analysis of the transfer patterns from more than 100 U.S. community hospitals, Duke University Medical Center researchers have found that fewer than one of five high-risk patients presenting with unstable angina or non-ST-segment elevation myocardial infarction (UA/NSTEMI) were quickly transferred to tertiary facilities with the ability to reopen clogged arteries with an angioplasty or coronary bypass surgery procedure, as recommended by the leading U.S. heart organizations.

The results of this analysis, the first such comprehensive look at this issue at community hospitals, highlights a crucial weakness in the delivery of cardiac care that should be addressed to improve the outcomes of patients with heart attacks, the researchers said. They cited recommendations of the American College of Cardiology (ACC) and the American Heart Association (AHA) that certain high-risk patients should be treated invasively within the first 48 hours of arriving at the hospital.

According to their analysis, only 18.7 percent of these high-risk patients with UA/NSTEMI were transferred to a tertiary hospital within 48 hours of presenting to a community hospital with symptoms of a heart attack. An additional 27.2 percent were transferred more than 48 hours after presentation.

Ironically, mortality rates for the patients not transferred are higher, mainly because the younger, healthier heart patients tend to be quickly transferred to tertiary care institutions while the sickest patients remain at community hospitals, the researchers said.

The results of the current analysis were presented today (March 7, 2004) by Duke cardiologist Matthew Roe, M.D., at the annual scientific sessions of the ACC.

"Paradoxically, we found that those high-risk patients who would stand to benefit the most from early invasive care were the least likely to be transferred to a facility capable o

Contact: Richard Merritt
Duke University Medical Center

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