Original articleIn-hospital Mortality Due to Acute Myocardial Infarction. Relevance of Type of Hospital and Care Provided. RECALCAR StudyMortalidad intrahospitalaria por infarto agudo de miocardio. Relevancia del tipo de hospital y la atención dispensada. Estudio RECALCAR
Section snippets
INTRODUCTION
In Spain and the majority of the developed countries, heart disease1 constitutes a considerable health care burden as it is responsible for 22% of overall mortality and is the most common cause of in-hospital morbidity.1, 2, 3 Improvements in its treatment have contributed to the increase in life expectancy, with returns on the investment made in terms of cost-effectiveness.4 These achievements are due in large part to new therapies and management strategies and to good clinical administration
METHODS
For a more detailed description of the methodology used, the reader can consult the supplementary material.
RESULTS
Significant differences were observed between the means of the RSMR related to cluster type (Table 7), to the services responsible for discharging the patients (Table 8), and to the type of procedure performed (Table 9). The F statistic provided by analysis of variance was significant in every case (P<.05), and when differences in the error variances were detected, the Kruskall-Wallis test was applied and the null hypothesis rejected. Table 7, Table 8, Table 9 show the results obtained for the
DISCUSSION
This study demonstrates that, in the Spanish NHS, the probability of in-hospital survival after AMI is associated with the characteristics of the hospital, as well as with whether the discharge is carried out by the cardiology service and whether angioplasty has been performed (Fig. 2).
The recommendations of clinical practice guidelines24, 25, 26 and national agencies27, 28, 29, 30 have promoted the development of health care networks to guarantee access of patients with AMI to angioplasty as
CONCLUSIONS
The most relevant conclusion of this study is probably that, in the Spanish NHS, the differences between hospitals help to explain the variation in the individual probability of dying from AMI. The type of hospital, the provision of care by a cardiology service, and the performance of a percutaneous coronary intervention are variables that, in this study, are independently and significantly associated with the survival of AMI patients admitted to NHS hospitals. We recommend the creation of care
FUNDING
This work for this report was funded by an unconditional grant from Menarini.
CONFLICTS OF INTEREST
None declared.
Acknowledgements
The authors thank the Spanish Ministry of Health, Social Services, and Equality for the facilities it has made available to the Spanish Society of Cardiology for the development of the RECALCAR study, with special gratitude to the General Directorate of Public Health, Quality, and Innovation and to Dr. María Ángeles Gogorcena and Dr. Mercedes Álvarez of the Spanish Health Information Institute.
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