Vancouver General Hospital, Vancouver, British Columbia, Canada.
Providence Health Care Research Institute, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Can J Cardiol. 2014 Dec;30(12):1562-9. doi: 10.1016/j.cjca.2014.09.008. Epub 2014 Sep 16.
Transfer patterns, procedure rates, and outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) presenting to Canadian community hospitals are not well understood.
We documented all patients admitted to British Columbia (BC) hospitals with a primary diagnosis of NSTEMI between 2007 and 2008. Patients were divided by admitting hospital type into tertiary care hospitals, nonremote community hospitals, and remote community hospitals. The aims were to compare transfer rates and time to transfer to a tertiary hospital as well as procedure rates and outcomes at index admission, at 30 days, and at 1 year.
The mean transfer rates to a tertiary hospital were 72.6% for nonremote and 57.1% for remote community hospitals (P < 0.001). Times to and rates of cardiac procedures differed significantly among these 3 hospital types. Admission to a nonremote or remote community hospital was associated with similar 1-year mortality compared with admission to a tertiary care hospital (nonremote hospitals, adjusted odds ratio [OR], 0.87; P = 0.26; remote hospitals, adjusted OR, 1.19; P = 0.33). At 1 year, admission to a nonremote community hospital was associated with a lower composite outcome of death or readmission for acute myocardial infarction (AMI) (adjusted OR, 0.80; P = 0.04).
One-year mortality rates were not different between patients with NSTEMI admitted to BC community and tertiary care hospitals; however, the rate of readmission for AMI/death was significantly less in patients admitted to nonremote community hospitals. This should prompt the evaluation of key outcomes in NSTEMI in other community hospital settings.
加拿大社区医院收治的非 ST 段抬高型心肌梗死（NSTEMI）患者的转院模式、治疗率和预后情况尚不清楚。
我们记录了 2007 年至 2008 年期间不列颠哥伦比亚省（BC）所有因 NSTEMI 住院的患者。根据入院医院类型，患者分为三级护理医院、非偏远社区医院和偏远社区医院。目的是比较转院率和转至三级医院的时间，以及在指数入院、30 天和 1 年时的治疗率和预后。
非偏远社区医院和偏远社区医院的平均转院至三级医院的比例分别为 72.6%和 57.1%（P < 0.001）。这 3 种医院类型的转院时间和心脏介入治疗率存在显著差异。与入住三级护理医院相比，入住非偏远或偏远社区医院的 1 年死亡率相似（非偏远医院校正优势比[OR]为 0.87，P = 0.26；偏远医院校正 OR 为 1.19，P = 0.33）。1 年后，与入住三级护理医院相比，入住非偏远社区医院的患者死亡或因急性心肌梗死（AMI）再入院的复合结局发生率更低（校正 OR 为 0.80，P = 0.04）。
在不列颠哥伦比亚省社区和三级护理医院接受 NSTEMI 治疗的患者的 1 年死亡率无差异，但与入住三级护理医院的患者相比，入住非偏远社区医院的患者因 AMI/死亡再次入院的比率显著降低。这应促使人们在其他社区医院环境中评估 NSTEMI 的关键结局。
