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Yale authors raise concerns regarding regionalized heart attack care

Calls to regionalize the care of patients with heart attacks are premature, and do not account for potential unintended consequences, according to a commentary by Yale researchers published in today's Journal of the American Medical Association (JAMA).

"Much of the enthusiasm for the regionalization of heart attack care has focused on what its upsides may be, without adequately considering how realistic some of these benefits are or the potential negative implications of such a policy, " notes Harlan M. Krumholz, M.D., professor of internal medicine (cardiology) and Epidemiology and Public Health (Health Policy and Administration).

Calls for the regionalization of acute coronary syndromes (heart attacks as they are more commonly called) are based on recently published studies conducted predominantly in Europe that suggest that transferring patients from smaller hospitals to larger hospitals so they might receive interventional therapies could reduce mortality, Krumholz writes. "The health care system in the United States is clearly not the same as Europe," Krumholz notes. "Patients are farther from hospitals and our EMS doesn't have experience recognizing the specific group of patients who will benefit from these treatments. It only seems reasonable that we should test for ourselves in the United States whether such a system works before we adopt it."

Saif Rathore, the study's first author and a second-year medical student at the Yale School of Medicine, is also concerned about the feasibility of regionalization. "Proponents often compare regionalization of acute coronary syndrome care to trauma, because trauma care is regionalized," Rathore said. "That's an unfair comparison. Any four-year-old can recognize trauma. Recognizing acute coronary syndromes care is much more complicated. There's an impression that real-life heart attacks are like those portrayed on television, where patients clutch their chests and fall to the floor. That's not
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Contact: Karen N. Peart
karen.peart@yale.edu
203-432-1326
Yale University
17-Mar-2005


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