Patients are far more likely to survive a heart attack if they are admitted directly to a high-volume hospital rather than a smaller one, according to a study of nearly 100,000 patients by researchers at Johns Hopkins.

Results of the study, published in the May 27 issue of The New England Journal of Medicine, found that Medicare patients were 17 percent more likely to survive a heart attack if they initially were seen at a medical center that handles large numbers of such patients rather than a low-volume hospital, a difference of 2.3 lives per 100 patients.

The volume effect was particularly strong among younger patients, whose survival was more than 30 percent better at high-volume centers.

The overall experience of the hospital's medical team appeared to be the key advantage in the increased survival rate, says David R. Thiemann, M.D., lead author of the study and assistant professor of medicine at Hopkins. The presence of high technology equipment and specialists were less important. The use of clot-dissolving agents, other medications, bypass surgery and angioplasty accounted for about a third of the survival benefit.

"We estimate that more than 5,000 lives each year potentially could be saved by taking patients with heart attacks directly to high-volume hospitals," Thiemann says. "Until now, patients with chest pain typically have been taken by ambulance to the nearest hospital because transport time is important. Our study suggests that in urban and suburban areas, the hospital-volume effect may outweigh minor transport delays. Heart attack patients may benefit from a field triage system like that used for patients with major injuries, who are taken directly to specialized trauma centers.

"This does not mean," he cautioned, "that people should drive themselves across town for treatment rather than call an ambulance. But it does suggest that changes in the emergency medical system could dram
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Contact: Karen Infeld
kinfeld@jhmi.edu
410-955-1534
Johns Hopkins Medical Institutions
27-May-1999