Long-term Outcomes of Patients with Acute Myocardial Infarction Presenting to Regional and Remote Hospitals

Sradha Kotwal, Isuru Ranasinghe, David Brieger, Philip Clayton, Alan Cass, Martin Gallagher

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Acute myocardial infarction (AMI) has poorer outcomes in disadvantaged populations such as those in regional and remote locations. We compared long-term outcomes associated with presentation to regional or remote hospitals among AMI patients. Methods and Results: Administrative claims data from New South Wales (27% regional and remote residents) was used to identify patients >18 years admitted to any NSW hospital with a principal diagnosis of AMI (ICD10 codes: I21·0-I21·4) between 01/07/2004 and 30/06/2008. Hospital of presentation location with a population of <250,000 was defined as regional and remote while hospitals with a population >250,000 were deemed urban. Receipt of revascularisation and mortality were analysed and adjusted for age, comorbidities and previous revascularisation. Patients were censored at death or end of the follow-up period (31 December 2009).39,798 patients were identified with 9,393 (23.6%) regional and remote presenters. In multivariable models, regional and remote presentation was associated with reduced rates of revascularisation (OR 0.30 95%CI 0.28-0.32; p<0.001), no impact on overall mortality (HR 1.04 95%CI 0.99-1.02; p=0.11), but with increased mortality for patients presenting with STEMI (HR 1.14; 95% CI 1.06-1.23; p<0.001). The propensity analysis was consistent with these findings. Conclusions: Presentation to a regional and remote hospital was associated with lower revascularisation rates following AMI, but with a higher long-term mortality if presenting with ST segment elevation.

LanguageEnglish
Pages124-131
Number of pages8
JournalHeart Lung and Circulation
Volume25
Issue number2
DOIs
Publication statusPublished - 1 Feb 2016
Externally publishedYes

Keywords

  • Epidemiology
  • Mortality
  • Myocardial infarction
  • Revascularisation
  • Statistics

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Kotwal, Sradha ; Ranasinghe, Isuru ; Brieger, David ; Clayton, Philip ; Cass, Alan ; Gallagher, Martin. / Long-term Outcomes of Patients with Acute Myocardial Infarction Presenting to Regional and Remote Hospitals. In: Heart Lung and Circulation. 2016 ; Vol. 25, No. 2. pp. 124-131.
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abstract = "Background: Acute myocardial infarction (AMI) has poorer outcomes in disadvantaged populations such as those in regional and remote locations. We compared long-term outcomes associated with presentation to regional or remote hospitals among AMI patients. Methods and Results: Administrative claims data from New South Wales (27{\%} regional and remote residents) was used to identify patients >18 years admitted to any NSW hospital with a principal diagnosis of AMI (ICD10 codes: I21·0-I21·4) between 01/07/2004 and 30/06/2008. Hospital of presentation location with a population of <250,000 was defined as regional and remote while hospitals with a population >250,000 were deemed urban. Receipt of revascularisation and mortality were analysed and adjusted for age, comorbidities and previous revascularisation. Patients were censored at death or end of the follow-up period (31 December 2009).39,798 patients were identified with 9,393 (23.6{\%}) regional and remote presenters. In multivariable models, regional and remote presentation was associated with reduced rates of revascularisation (OR 0.30 95{\%}CI 0.28-0.32; p<0.001), no impact on overall mortality (HR 1.04 95{\%}CI 0.99-1.02; p=0.11), but with increased mortality for patients presenting with STEMI (HR 1.14; 95{\%} CI 1.06-1.23; p<0.001). The propensity analysis was consistent with these findings. Conclusions: Presentation to a regional and remote hospital was associated with lower revascularisation rates following AMI, but with a higher long-term mortality if presenting with ST segment elevation.",
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Long-term Outcomes of Patients with Acute Myocardial Infarction Presenting to Regional and Remote Hospitals. / Kotwal, Sradha; Ranasinghe, Isuru; Brieger, David; Clayton, Philip; Cass, Alan; Gallagher, Martin.

In: Heart Lung and Circulation, Vol. 25, No. 2, 01.02.2016, p. 124-131.

Research output: Contribution to journalArticle

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AU - Ranasinghe, Isuru

AU - Brieger, David

AU - Clayton, Philip

AU - Cass, Alan

AU - Gallagher, Martin

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