LOS ANGELES -- As reported in a recent issue of the New England Journal of Medicine, researchers studying statistics of elderly heart attack patients found that those treated at "high-volume" hospitals had better odds of survival than those taken to hospitals that treat a relatively low number of heart attacks.
Prediman K. Shah, M.D., Director of the Division of Cardiology at Cedars-Sinai Medical Center -- one of the most respected heart programs in the nation -- says the results provide intriguing observations that, if confirmed by subsequent studies, may lead to a re-examination of paramedic transport policies. Presently, because emergency intervention needs to be started quickly during a heart attack, nearly all jurisdictions require ambulances to take heart attack patients to the nearest hospital.
"The implications of this study are very interesting," according to Dr. Shah. "What it says is that if you are experiencing a heart attack, you will have a somewhat better chance of surviving if the ambulance takes you to the nearest large-volume hospital rather than just the nearest hospital."
The researchers reviewed results of treatment received by 98,898 Medicare patients who were suffering myocardial infarctions (heart attacks) when admitted to hospitals. Those hospitals were divided into four groups, or quartiles, based on volume. Outcomes from the lowest-quartile hospitals were then compared with those in the highest quartile. In assessing the data, adjustments were made to account for differences in severity of illness and other factors.
"The difference in outcome was such that approximately 2.3 extra deaths occurred per 100 patients in the lowest-volume hospitals, compared to the highest," says Dr. Shah. "So the difference in mortality was up nearly 2 deaths per hundred patients."
Access to higher technology equipment at higher volume hospitals did not turn
out to be a relevant factor. The principal difference, according to the report
Contact: Sandra Van
Cedars-Sinai Medical Center