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
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