Are All Hospitals Created Equal When Treating Unstable Angina?
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
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