Direct admission versus interhospital transfer for revascularisation in non‐ST‐segment elevation myocardial infarction

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 46; no. 8; pp. 997 - 1006
• Main Authors: Steenbergen, Gijs J., Demandt, Jesse P. A., Schulz, Daniela N., Tonino, Pim A., Dekker, Lukas, Vermeer‐Gerritzen, Iris, Wijnbergen, Inge F., Thijssen, Eric J. M., Theunissen, Luc J. H. J., Heijmen, Eric P. C. M., Haest, Rutger J. P., Vlaar, Pieter‐Jan, Veghel, Dennis
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.08.2023; John Wiley and Sons Inc
• Subjects: Angioplasty; Asthma; cardiology; cardiothoracic surgery; Clinical Trial Result; Coronary vessels; Costs; Diabetes; Emergency medical care; ESC; Heart attacks; Heart surgery; Hospitals; Mortality; NSTEMI; patient value; Patients; Registration; Reimbursement; value‐based healthcare; Netherlands; NSTEMI; patient value; cardiothoracic surgery; ESC; value-based healthcare; cardiology
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.24060

Background The differences in outcomes and process parameters for NSTEMI patients who are directly admitted to an intervention centre and patients who are first admitted to a general centre are largely unknown. Hypothesis There are differences in process indicators, but not for clinical outcomes, for NSTEMI who are directly admitted to an intervention centre and patients who are first admitted to a general centre. Methods We aim to compare process indicators, costs and clinical outcomes of non‐ST‐segment elevation myocardial infarction (NSTEMI) patients stratified by center of first presentation and revascularisation strategy. Hospital claim data from patients admitted with a NSTEMI between 2017 and 2019 were used for this study. Included patients were stratified by center of admission (intervention vs. general center) and subdivided by revascularisation strategy (PCI, CABG, or no revascularisation [noRevasc]). The primary outcome was length of hospital stay. Secondary outcomes included: duration between admission and diagnostic angiography and revascularisation, number of intracoronary procedures, clinical outcomes at 30 days (MACE: all‐cause mortality, recurrent myocardial infarction and cardiac readmission) and total costs (accumulation of costs for hospital claims and interhospital ambulance rides). Results A total of 9641 NSTEMI events (9167 unique patients) were analyzed of which 5399 patients (56%) were admitted at an intervention center and 4242 patients to a general center. Duration of hospitalization was significantly shorter at direct presentation at an intervention centre for all study groups (5 days [2–11] vs. 7 days [4–12], p < 0.001). For PCI, direct presentation at an intervention center yielded shorter time to diagnostic angiography (1 day [0–2] vs. 1 day [1–2], p < 0.01) and revascularisation (1 day [0–3] vs. 4 days [1–7], p < 0.001) and less intracoronary procedures per patient (2 [1–2] vs. 2 [2–2], p < 0.001). For CABG, time to revascularisation was shorter (8 days [5–12] vs. 10 days [7–14], p < 0.001). Total costs were significantly lower in case of direct presentation in an intervention center for all treatment groups €10.211 (8750–18.192) versus €13.741 (11.588–19.381), p < 0.001) while MACE was similar 11.8% versus 12.4%, p = 0.344). Conclusion NSTEMI patients who were directly presented to an intervention center account for shorter duration of hospitalization, less time to revascularisation, less interhospital transfers, less intracoronary procedures and lower costs compared to patients who present at a general center. Patients directly admitted to intervention centers for non‐ST‐segment elevation myocardial infarction had shorter hospital stays and reduced costs compared to those admitted to general centers. However, logistical challenges and inconsistent clinical benefits suggest alternative approaches like improved prehospital triage and streamlined regional arrangements should be explored for optimizing resources and outcomes.