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Are All Hospitals Created Equal When Treating Unstable Angina?


WebMD Health News

Dec. 3, 1999, (Atlanta) -- When it comes to a heart condition called unstable angina, patients admitted first to smaller, less well-equipped local hospitals may fare just as well as those who go directly to high-tech, specialized hospitals. That's according to a study in the current issue of the Journal of the American College of Cardiology.

In the study, patients admitted to more-specialized hospitals, also called tertiary hospitals, were more likely to receive invasive procedures -- angiography (injection of dye into the vessels of the heart through the leg vein), bypass surgery, or angioplasty (enlarging a blocked vessel with a balloon or other method) -- than those who headed for the nearest community hospital. But even if treatment was delayed so that patients could be transferred to the larger hospital, they still did well, says Josep Lupón, MD, of Hospital Universidad Germans in Badalona, Spain, lead researcher of the study.

The study involved 791 patients admitted to four teaching hospitals in Spain, one of which had tertiary facilities. All were admitted with unstable angina, and none had a history of heart attack. Patients were tracked six months after hospital admission.

Researchers found that 70% of those admitted to the tertiary center had an invasive coronary procedure, with the longest delay in treatment being 24 hours. Fifty percent of those admitted to non-tertiary hospitals eventually had those same procedures, although it was delayed an average of four days. The numbers of patients who died or were readmitted were "not statistically significant," says Lupón.

However, 26 nontertiary-first patients (5.3%) died in the six-month follow-up period, versus 12 patients (3.9%) in the tertiary-first group, John Douglas, MD, associate professor of medicine at Emory University, tells WebMD in an interview seeking objective opinion. "[The authors] said that percentage didn't make a difference, but it's pretty important for those patients who make up that difference," says Douglas. "There weren't enough people in the study to make those numbers statistically significant, but if they'd had a couple [of] thousand patients, it would have been."

Sayed Feghali, MD, an interventional cardiologist with the Texas Heart Institute in Houston, tells WebMD, "It's an important question, even for us in the U.S., because we have the same scenario. ... A lot of patients are admitted to hospitals on the periphery and not to large medical centers.

"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.

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