Do you really need that cath lab?
Patients do as well; hospital saves $2,500
When patients with acute myocardial infarction (AMI) are admitted to hospitals without on-site catheterization facilities, they are managed with fewer procedures, yet the outcome is similar to that of cases admitted to tertiary centers with cath labs. The conservative approach results in no increase in long-term mortality rates, states a recent study.1, 2
A research team at the University of Washington in Seattle led by Nathan R. Every, MD, reviewed registry data on over 12,000 AMI patients admitted to 19 local hospitals. Two-thirds of patients who entered hospitals with on-site cath labs underwent angiography during initial hospitalization. In contrast, about 39% of patients entering hospitals without on-site cath labs underwent angiography.
The patients who entered hospitals with on-site cath labs were more likely to undergo angioplasty than those entering hospitals without on-site cath labs 32.5% vs. 13.2% and rates of coronary artery bypass surgery were higher as well 12.5% vs. 9.5%. At a three-year follow up, those admitted to hospitals with on-site cath labs were more likely to have undergone angiography and angioplasty after discharge, with higher cumulative costs per patient of about $2,500.
"If your hospital doesn’t have a cath lab but is in a city where you can easily transport patients," he says, "you can still provide quality care. You don’t have to go to the expense of putting in a cath lab. Your procedure use is lower, and outcomes would be comparable to hospitals with cath lab facilities."
The majority of hospitals around the country are not equipped with cath labs. Some experts argue that top-quality AMI care can only take place in tertiary centers with cath labs. That’s not necessarily the case, states Every, as long as transfer can be done easily.
References
1. Every NR, Parsons LS, Fihn SD, et al. Long-term outcome in acute myocardial infarction patients admitted to hospitals with and without on-site cardiac catheterization facilities. Circulation 1997; 96:1,770-1,775.
2. Schlant RC. Does the presence of an on-site cardiac catheterization facility in a hospital alter the long-term outcome of patients admitted with acute myocardial infarction? Editorial. Circulation 1997; 96:1,711-1,712.
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