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Patients with heart problems fare better at cardiac hospitals than general hospitals

Patients who suffer heart attacks or congestive heart failure fare slightly better if they are in hospitals that specialize in cardiac care instead of general hospitals, a new study reveals.

Brahmajee K. Nallamothu, M.D., M.P.H., of Ann Arbor Veterans Affairs Medical Center and the University of Michigan Medical School and colleagues compared the 30-day survival of Medicare patients who had heart attacks or congestive heart failure and were seen at one of 16 cardiac (1,912 patients) or 121 general hospitals (13,158 patients) in 2003.

Researchers found a lower 30-day mortality rate for patients with heart attacks who were treated in cardiac instead of general hospitals (14.8 vs. 16.2 percent). Similarly, the mortality rate for patients with congestive heart failure was 10.7 percent for cardiac hospitals and 11.4 percent for general hospitals.

These modest differences in survival may be explained by the types of patients the different hospitals care for, the authors suggest. For instance, patients seen at general hospitals may have other health conditions that require the multidisciplinary care those hospitals provide, precluding them from being seen at a specialty hospital. This "cherry picking" may give the specialty hospitals better outcome scorecards and force general hospitals to take on more severely ill patients and more financial risk, the authors suggest.

On the other hand, specialty hospitals may score better than general hospitals, because they allow providers to concentrate on a specific area and to develop skilled staff and resources to deliver specialized care. Another possibility is that physicians who set up cardiac hospitals may just be better physicians than their counterparts who practice elsewhere. Although this study raised these issues, it was unable to document the extent to which these differences were explained by these factors. A better understanding of these issues and the dissemination of approaches to care that are unique to these facilities may ultimately improve care provided to all cardiac patients.

This study was funded in part by the Agency for Healthcare Research and Quality (HS15571).

See "Acute myocardial infarction and congestive heart failure outcomes at specialty cardiac hospitals," by Dr. Nallamothu, Yongfei Wang, M.S., Peter Cram, M.D., M.B.A., and others in the November 13, 2007, Circulation 116, pp. 2280-2287.

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