Karlson B W, Karlsson T, Kalin B, Svensson L, Zehlertz E, Herlitz J
Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Eur J Emerg Med. 2000 Dec;7(4):277-86. doi: 10.1097/00063110-200012000-00005.
The aim of this study was to compare the characteristics and outcome for patients coming to the emergency department with acute chest pain in a city university hospital, representing an urban area, and a county hospital, representing a rural area. This was a retrospective survey of all chest pain patients at Sahlgrenska University Hospital, Göteborg, covering an area with 706 inhabitants/km2, and at Uddevalla County Hospital, Uddevalla, covering an area with 34 inhabitants/km2, over a period of 6 months. In all 2,297 patients were registered at Sahlgrenska University Hospital and 1062 at Uddevalla Hospital (per 100,000 inhabitants and year 1,502 and 1,342 patients, respectively). The patients in the urban area were more frequently sent home from the emergency department than in the rural area (30% versus 23%; p < 0.0001). Patients in the urban area had a lower prevalence of previous cardiovascular diseases. An obvious acute myocardial infarction (AMI) or a strong suspicion of AMI at initial evaluation was less frequent in the urban area whereas no suspicion of AMI was twice as common (46% versus 24%; p < 0.0001). Furthermore, there was a difference in the use of medications; various cardiovascular drugs were more frequently used in the rural area. Despite these differences at baseline the 30-day mortality was similar (3.5% in the urban area and 3.6% in the rural area; NS), as well as the 2-year mortality (14.0% and 12.7%, respectively; NS). It is concluded that the number of patients admitted to the emergency department with acute chest pain/100,000 was slightly higher in the urban than in the rural area. Patients in the urban area differed from those in the rural area having a lower prevalence of previous cardiovascular diseases, a lower initial suspicion of AMI, they were less frequently hospitalized and less frequently prescribed various cardiovascular drugs. Mortality did not differ between the two cohorts.
本研究旨在比较在一所代表市区的城市大学医院和一所代表农村地区的县医院急诊科就诊的急性胸痛患者的特征及预后。这是一项对哥德堡萨尔格伦斯卡大学医院（覆盖面积为每平方公里706名居民）和于德韦拉县医院（于德韦拉，覆盖面积为每平方公里34名居民）的所有胸痛患者进行的回顾性调查，为期6个月。萨尔格伦斯卡大学医院共登记了2297例患者，于德韦拉医院登记了1062例患者（每10万居民和每年分别为1502例和1342例患者）。市区患者从急诊科回家的频率高于农村地区（30%对23%；p<0.0001）。市区患者既往心血管疾病的患病率较低。在初始评估时，明显的急性心肌梗死（AMI）或强烈怀疑AMI在市区的发生率较低，而无AMI怀疑的情况在市区是农村的两倍（46%对24%；p<0.0001）。此外，药物使用方面存在差异；农村地区更频繁使用各种心血管药物。尽管基线存在这些差异，但30天死亡率相似（市区为3.5%，农村地区为3.6%；无统计学意义），2年死亡率也相似（分别为14.0%和12.7%；无统计学意义）。得出的结论是，每10万人中因急性胸痛入住急诊科的患者数量在市区略高于农村地区。市区患者与农村地区患者不同，前者既往心血管疾病患病率较低，初始时对AMI的怀疑较低，住院频率较低，开具各种心血管药物的频率也较低。两个队列的死亡率没有差异。
