Tuesday, July 22, 2008

Community hospitals don't transfer many patients who need cardiac catheterization
by Kelly Winget

In a new analysis of the CRUSADE registry, DCRI researchers reviewed the frequency that community hospitals transfer patients who could benefit from cardiac catheterization which the community hospital is not equipped to provide. The study found that less than half of patients with acute coronary syndromes (ACS) are transferred to other hospitals.

The American College of Cardiology and the American Heart Association revised guidelines in 2007 for treating patients with ACS, which includes patients who have had a heart attack or who have unstable angina. The guidelines recommend revascularization treatments such as angioplasty or cardiac catheterization within the first 48 hours for high-risk patients. But as many as two-thirds of hospitals cannot perform these procedures and would need to transfer patients to a different hospital.

For the study, researchers analyzed patterns on more than 19,000 ACS patients who were admitted to 124 community hospitals which did not have the capabilities to perform the artery-widening procedures. The hospitals were part of the CRUSADE initiative. The study was led by the DCRI's Matthew Roe, MD, MHS, and results were published in the July issue of the American Heart Journal.

They found that only 46 percent of patients were transferred to other hospitals that could perform procedures such as cardiac catheterization. And of the patients who were transferred, only 20 percent were transferred within the ACC/AHA recommended 48 hours.

The patients who were most likely to be transferred were those at low- to moderate- risk for dying while in the hospital. Researchers found the patients that community hospitals were most likely to transfer were younger and did not have prior heart failure, even though previous studies have found that elderly and high-risk patients can potentially realize significant benefits from invasive approaches to managing ACS.

Researchers could not fully identify the factors that went into decisions not to transfer a larger percent of patients. They believe that further investigation is necessary to better identify the factors that impact transfer decisions and to improve risk-based decision making for patients at community hospitals.

Other DCRI researchers involved in the study include Anita Chen, MS, Elizabeth Delong, PhD, Robert Califf, MD, Magnus Ohman, MD, and Eric Peterson, MD, MPH.