NEW ORLEANS -- Where you live in America helps determine how a doctor treats your heart attack, how long you stay in the hospital, and whether you are likely to need further hospitalization in the next few months, researchers said Tuesday (Nov. 12) at the annual meeting of the American Heart Association.
Duke University Medical Center researchers used detailed medical, economic, and quality-of-life information for more than 2,300 patients across the United States to paint a picture of what regional differences exist in the treatment of heart attacks. They looked at both the initial hospitalization of these patients during 1990-1993, and they tracked what happened to them up to one year later.
They found that the rates of death and second heart attacks were almost the same across the country, but that the use of interventional procedures and hospital stays varied widely, more than they expected. "The contrasts were quite striking, including some large differences in efficiency that we did not expect, as well as some we anticipated," said Eric Eisenstein, who specializes in economic analysis at the Duke Clinical Research Institute.
He said that, based on the new data, the Mid-Atlantic region was the most expensive region in treating heart attacks through one year of follow-up, and that the Mountain and Pacific states, where managed care was reputedly more widespread during the study period, rated the best for both the initial hospitalization and up to a year later.
"This could upset prevailing views in several ways," said Duke cardiologist Dr. Daniel Mark, who oversaw the analysis. "Northeastern hospitals have always been held up as the most cost-efficient, but early studies concentrated on the use of invasive cardiac procedures during the initial hospitalization. The picture changes when you look at what actually happens to a patient over the span of a year.