Copyright © 2001 by the European Society of Cardiology.
Differences in treatment and outcome of patients with acute myocardial infarction admitted to hospitals with compared to without departments of cardiology. Results from the pooled data of the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA 1+2) Registries and the Myocardial Infarction Registry (MIR)
a The Städtisches Klinikum, Nürnberg, Germany
b Herzzentrum Ludwigshafen, Kardiologie, Germany
c The Robert Koch Krankenhaus, Gehrden, Germany
d The Klinikum Westpfalz, Kaiserslautern, Germany
e The Klinikum Friedrichstadt, Dresden, Germany
f The Städtisches Klinikum, Dessau, Germany
revised February 5, 2001; accepted February 7, 2001
Abstract
Aims The specialty of the admitting physician may influence treatment and outcome in patients with acute myocardial infarction.
Methods and Results The pooled data of three German acute myocardial infarction registries: the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) 1+2 studies and the Myocardial Infarction Registry (MIR) were analysed. Patients admitted to hospitals with departments of cardiology were compared to hospitals without such departments. A total of 24814 acute myocardial infarction patients were included, 9020 (36%) patients at 91 (29·8%) hospitals with departments of cardiology and 15794 (64%) at 214 (70·2%) hospitals without cardiology departments. There were only minor differences in patient characteristics and prevalence of concomitant diseases between the two types of hospital. The first electrocardiogram was more often diagnostic at hospitals with cardiology departments (71·8% vs 66·5%, P<0·001). Reperfusion therapy and adjunctive medical therapy, such as aspirin, beta-blockers and ACE-inhibitors were used more often at cardiology departments (all P -values <0·001), even after adjustment for confounding parameters. Treatment improved at both types of hospital over time. Admission to a hospital with a department of cardiology was independently associated with a lower hospital mortality (14·2% vs 15·4%, adjusted OR=0·91; 95%CI: 0·83–0·99). Additional logistic regression models showed that the higher use of reperfusion therapy and recommended concomitant medical therapy was responsible for most of the survival benefit at such hospitals.
Conclusion Treatment of acute myocardial infarction patients at hospitals with departments of cardiology was independently associated with a higher use of recommended therapy and a lower hospital mortality compared to hospitals without such departments.
Key Words: Acute myocardial infarction, primary angioplasty, thrombolysis, quality of health care, cardiology
f1 Drs Gottwik and Zahn contributed equally to this work.
f2 Correspondence: R. Zahn, MD, Herzzentrum Ludwigshafen, Department of Cardiology, Bremserstr. 79, 67069 Ludwigshafen am Rhein, Germany.
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