Are All Hospitals Created Equal When Treating Unstable Angina?
"If you live 60 miles from here and have [an] acute urgent [angina] problem, you need to go to the closer hospital and not go to [a] medical center because something could happen on the way. I think this kind of study reinforces that point ... that patients admitted to smaller hospitals are well served and are transferred ... appropriately," says Feghali who is also director of the Coronary Care Unit at St. Luke's Episcopal Hospital, also in Houston.
Are excess numbers of invasive procedures performed in tertiary hospitals? Feghali says, "the difference in the frequency was not that great, if you look at the numbers. Seventy percent in a tertiary hospital had heart catheterization vs. 50% ... it's not a big spread."
Adds Douglas, "This issue [whether to treat unstable angina aggressively or not] has been around for a long time, and this paper doesn't really solve it. But it makes some interesting observations."
One reason why unstable angina may be treated differently in various hospitals lies in the nature of the symptoms, says Feghali. "In extreme cases, it's clear-cut what to do, but in the gray area, where most patients are, there's a lot of variability in how physicians approach it. In Canada, usage of invasive procedures for this diagnosis is about twice the rate [as in the U.S.]," he says.
The bottom line for consumers, Feghali says, is this: If you have an angina problem, go to the closest hospital, ask questions, know what's going on, and keep being updated to what's going on.
- For patients with unstable angina, the size of the hospital may not matter with respect to patient outcomes.
- In a recent study, those admitted to specialized centers were more likely to undergo invasive procedures compared to community hospitals, but the rates of readmittance and death were similar for both.
- In an emergency, patients should head to the nearest hospital for care.