Acute Myocardial Infarction Complicated by Early Onset of Heart Failure:

Bednář, František; Widimský, Petr; Groch, Ladislav; Aschermann, Michael; Želı́zko, Michael; Krupicka, J

doi:10.1034/j.1600-0854.2003.8047.x

Cited by 9 publications

(4 citation statements)

References 41 publications

(44 reference statements)

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“…Nonetheless, since not all hospitals are capable of providing such specialized care, especially in rural areas, structured referral networks have to be in place to shorten time to access experienced specialized centers. We, like others [31,39], found that, irrespective of acute coronary syndrome type, those transferred were more likely to have been admitted to a non-PCI capable hospital, be transferred for coronary angiography and/or revascularization and less likely to die. Ranasinghe et al undertook a retrospective cohort analysis of >40,000 MI patients admitted to one of 161 hospitals in Australia, between 2004 and 2008, and found that, independently from age, type of MI and type of referring hospital, those transferred were also more likely to receive PCI and less likely to die in hospital, at 30 days and at 1 year follow-up [31].…”

Section: Predictors Of Iht and 30-day Rehospitalizationssupporting

confidence: 70%

Time-trends and predictors of interhospital transfers and 30-day rehospitalizations after acute coronary syndrome from 2000-2015

et al. 2021

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Aims Assess trends and factors associated with interhospital transfers (IHT) and 30-day acute coronary syndrome (ACS) rehospitalizations in a national administrative database of patients admitted with an ACS between 2000–2015. Methods and results Cohort study of patients hospitalized with ACS from 2000 to 2015, using a validated linkage algorithm to identify and link patient-level sequential hospitalizations occurring within 30 days from first admission (considering all hospitalizations within the 30-day timeframe as belonging to the same ACS episode of care-ACS-EC). From 212,481 ACS-EC, 42,670 (20.1%) had more than one hospitalization. ACS-EC hospitalization rates decreased throughout the study period (2000: 207.7/100.000 person-years to 2015: 185,8/100,000 person-years, p for trend <0.05). Proportion of IHT increased from 10.5% in 2000 to 20.1% in 2015 compared to a reduction in both planned and unplanned 30-day ACS rehospitalization from 9.0% in 2000 to 2.7% in 2015. After adjusting for patient and first admission hospital’s characteristics, compared to 2000–2003, in 2012–2015 the odds of IHT increased by 3.81 (95%CI: 3.65–3.98); the odds of unplanned and planned 30-day ACS rehospitalization decreased by 0.36 (95%CI: 0.33; 0.39) and 0.47 (95%CI: 0.43; 0.53), respectively. Female sex, older age and the presence and severity of comorbidities were associated with lower likelihood of being transferred or having a planned 30-day ACS rehospitalization. Unplanned 30-day ACS rehospitalization was more likely in patients with higher comorbidity burden. Conclusion IHT and 30-day ACS rehospitalization reflect coronary referral network efficiency and access to specialized treatment. Identifying factors associated with higher likelihood of IHT and 30-day ACS rehospitalization may allow heightened surveillance and interventions to reduce rehospitalizations and inequities in access to specialized treatment.

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Section: Predictors Of Iht and 30-day Rehospitalizationssupporting

confidence: 70%

Time-trends and predictors of interhospital transfers and 30-day rehospitalizations after acute coronary syndrome from 2000-2015

et al. 2021

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“…21) Transport for angioplasty (groups B and C) reduced mortality, especially in group C. 15) Patients who died in group A probably suffered from severe left ventricle dysfunction and could not influence the final EF and WMSI values while the group B and C patients with the lowest EF values who survived thanks to coronary angioplasty did so. 29) We conclude that this fact explains the discrepancies between great reductions in the combined primary end-point in group C and the small improvements in EF and WMSI in the same group.…”

Section: Discussionmentioning

confidence: 77%

Inter-hospital Transport for Primary Angioplasty Does Not Compromise Left Ventricular Function

et al. 2003

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SUMMARYThe main aim of the present study was to investigate whether long distance interhospital transport for primary angioplasty (delayed mechanical reperfusion) influences the resulting left ventricular function after myocardial infarction as compared with thrombolysis at the nearest hospital (immediate pharmacological reperfusion).Primary coronary angioplasty is more effective than thrombolysis in restoring coronary flow in patients with acute myocardial infarction. It is not known whether a delay in reperfusion due to transport to an angioplasty centre compromises left ventricular function, and whether combination therapy (ie, thrombolysis during transport to an angioplasty centre) would help preserve ejection fraction.The "PRAGUE-1" Study randomised 300 patients with myocardial infarction admitted to community hospitals without a cath-lab into 3 groups: group A (thrombolysis, no transport, n = 99), group B (thrombolysis during transport to an angioplasty centre, n = 100), and group C (transport for primary angioplasty, n = 101). Transport distances were below 75 kilometres, and mean transport time was 38 minutes. This paper presents for the first time the echocardiographic data from the early (discharge, day 30) and mid-term (6 months) follow-up. Only patients who survived until discharge (A: 85, B: 88, C: 94) could be analysed.Ejection fraction improved between discharge and 6 months (P < 0.01) in all three groups: from 47% to 51% in group A, from 47% to 52% in group B, and from 48% to 52% in group C. The differences between the groups were not significant. The same differences were found for the wall motion score index. Left ventricular end-diastolic diameter did not differ between the groups/examinations. Greater improvement was documented in the period between hospital discharge and day 30, compared to the period between day 30 and 6 months.The time delay associated with an inter-hospital transport strategy for primary angioplasty did not compromise left ventricular function. The strategy of thrombolysis during transport did not further improve left ventricular function compared to transport for priFrom

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“… 19 In these cases, ECG diagnosis of STEMI would be performed by EMS personnel prior to emergency department (ED) arrival, or by ED personnel within 10 min of arrival; patients would then be emergently transported to a high-volume PCI centre within 30 min. 13 Clinical trials in Europe 8 9 20–22 and a recent trial in the USA 23 have shown that the routine transfer of patients with STEMI to PCI centres is safe and feasible, and can be accomplished rapidly within recommended time-to-reperfusion guidelines.…”

Section: Introductionmentioning

confidence: 99%

Routine diversion of patients with STEMI to high-volume PCI centres: modelling the financial impact on referral hospitals

et al. 2015

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ObjectiveTo quantify possible revenue losses from proposed ST-elevation myocardial infarction (STEMI) patient diversion policies for small hospitals that lack high-volume percutaneous coronary intervention (PCI) capability status (ie, ‘STEMI referral hospitals’).BackgroundNegative financial impacts on STEMI referral hospitals have been discussed as an important barrier to implementing regional STEMI bypass/transfer protocols. However, there is little empirical data available that directly quantifies this potential financial impact.MethodsUsing detailed financial charges from Florida hospital discharge data, we examined the potential negative financial impact on 112 STEMI referral hospitals from losing all inpatient STEMI revenue. The main outcome was projected revenue loss (PRL), defined as total annual patient with STEMI charges as a proportion of total annual charges for all patients. We hypothesised that for most community hospitals (>90%), STEMI revenue represented only a small fraction of total revenue (<1%). We further examined the financial impact of the ‘worst case’ scenario of loss of all acute coronary syndrome (ACS) (ie, chest pain) patients.ResultsPRLs were $0.33 for every $100 of patient revenue statewide for STEMI and $1.73 for ACS. At the individual hospital level, the 90th centile PRL was $0.74 for STEMI and $2.77 for ACS. PRLs for STEMI were not greater in rural areas compared with major metropolitan areas. Hospital revenue centres that would be most impacted by loss of patients with STEMI were cardiology procedures and intensive care units.ConclusionsLoss of patient with STEMI revenues would result in only a small financial impact on STEMI referral hospitals in Florida under proposed STEMI diversion/rapid transfer protocols. However, spillover loss of patients with ACS would increase revenue loss for many hospitals.

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Acute Myocardial Infarction Complicated by Early Onset of Heart Failure:

Cited by 9 publications

References 41 publications

Time-trends and predictors of interhospital transfers and 30-day rehospitalizations after acute coronary syndrome from 2000-2015

Time-trends and predictors of interhospital transfers and 30-day rehospitalizations after acute coronary syndrome from 2000-2015

Inter-hospital Transport for Primary Angioplasty Does Not Compromise Left Ventricular Function

Routine diversion of patients with STEMI to high-volume PCI centres: modelling the financial impact on referral hospitals

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