This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

A Comparison of Two University Hospitals

Louise Pilote, MD, MPH; Normand Racine, MD; Mark A. Hlatky, MD

Arch Intern Med. 1994;154(10):1090-1096.

Abstract
Objective
To compare practice patterns and clinical outcomes for a costly yet common condition, acute myocardial infarction.

Design
Retrospective cohort study in two university hospitals (Stanford [Calif] University and McGill University, Montreal, Quebec) and a patient survey.

Patients
All consecutive patients (n=518) treated for acute myocardial infarction in the coronary care unit of those two hospitals over 2 years.

Measures
Rates of diagnostic and therapeutic procedures, mortality, reinfarction, and level of functional status (by chart review and patient survey).

Results
Demographic and clinical characteristics were similar for the two groups. Noninvasive tests were more common at McGill (exercise tests, 56% vs 20%; tests of left ventricular function, 86% vs 59%; P<.0001 for both). In contrast, invasive procedures were more common at Stanford (angiography, 55% vs 34%; angioplasty, 30% vs 13%; and bypass surgery, 10% vs 4%; P<.0001). At a median follow-up of 20 months, reinfarction and mortality rates were similar at Stanford and McGill (13% vs 8% and 28% vs 27%, respectively; P>.05 for both). In contrast, the angina rate was slightly lower at Stanford (33% vs 40%; P=.15), and the functional status of Stanford patients was better than that of McGill patients (mean Duke Activity Status Index score, 28.8 and 22.9, respectively; P=.006). This functional status difference persisted after adjustment for differences in clinical factors, including coronary revascularization.

Conclusion
The aggressive treatment of the American patients with myocardial infarction did not improve reinfarction and mortality rates compared with the conservative treatment of the Canadian patients. The superior functional status of the American patients merits further investigation.

(Arch Intern Med. 1994;154:1090-1096)

Author Affiliations
From the Division of Cardiovascular Medicine, Department of Medicine, and the Division of Health Services Research, Department of Health Research and Policy, Stanford (Calif) University (Drs Pilote and Hlatky); and the McGill Unit for the Prevention of Cardiovascular Diseases, McGill University, Montreal, Quebec (Dr Racine). Dr Racine is now with the Cardiology Division, Notre-Dame Hospital, Montreal, Quebec.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Ecological Studies and Cardiovascular Outcomes Research
Tu and Ko
Circulation 2008;118:2588-2593.
FULL TEXT  

Predictors associated with the place of death in a country with increasing hospital deaths
Yun et al.
Palliat Med 2006;20:455-461.
ABSTRACT  

Geographical Differences in the Rates of Angiographic Restenosis and Ischemia-Driven Target Vessel Revascularization After Percutaneous Coronary Interventions: Results From the Prevention of Restenosis With Tranilast and its Outcomes (PRESTO) Trial
Singh et al.
J Am Coll Cardiol 2006;47:34-39.
ABSTRACT | FULL TEXT  

Are international differences in the outcomes of acute coronary syndromes apparent or real? A multilevel analysis
Chang et al.
J. Epidemiol. Community Health 2005;59:427-433.
ABSTRACT | FULL TEXT  

Predictive factors for ischemic target vessel revascularization in the Prevention of Restenosis with Tranilast and its Outcomes (PRESTO) trial
Singh et al.
J Am Coll Cardiol 2005;45:198-203.
ABSTRACT | FULL TEXT  

Long-Term Mortality of Patients With Acute Myocardial Infarction in the United States and Canada: Comparison of Patients Enrolled in Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO)-I
Kaul et al.
Circulation 2004;110:1754-1760.
ABSTRACT | FULL TEXT  

Quality of Life After Acute Myocardial Infarction Among Patients Treated at Sites With and Without On-site Availability of Angiography
Pilote et al.
Arch Intern Med 2002;162:553-559.
ABSTRACT | FULL TEXT  

Age-related differences in in-hospital mortality and the use of thrombolytic therapy for acute myocardial infarction
Boucher et al.
CMAJ 2001;164:1285-1290.
ABSTRACT | FULL TEXT  

Canadian-American Differences in the Management of Acute Coronary Syndromes in the GUSTO IIb Trial : One-Year Follow-Up of Patients Without ST-Segment Elevation
Fu et al.
Circulation 2000;102:1375-1381.
ABSTRACT | FULL TEXT  

Changes in the treatment and outcomes of acute myocardial infarction in Quebec, 1988-1995
Pilote et al.
CMAJ 2000;163:31-36.
ABSTRACT | FULL TEXT  

Cost-effectiveness of 3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase Inhibitors in the Secondary Prevention of Cardiovascular Disease: Forecasting the Incremental Benefits of Preventing Coronary and Cerebrovascular Events
Grover et al.
Arch Intern Med 1999;159:593-600.
ABSTRACT | FULL TEXT  

Elderly Patients Receive Less Aggressive Medical and Invasive Management of Unstable Angina: Potential Impact of Practice Guidelines
Giugliano et al.
Arch Intern Med 1998;158:1113-1120.
ABSTRACT | FULL TEXT  

Shopping Around for Hospital Services: A Comparison of the United States and Canada
Bell et al.
JAMA 1998;279:1015-1017.
ABSTRACT | FULL TEXT  

Regional Variation across the United States in the Management of Acute Myocardial Infarction
Pilote et al.
NEJM 1995;333:565-572.
ABSTRACT | FULL TEXT  

Variation in the Use of Cardiac Procedures after Acute Myocardial Infarction
Guadagnoli et al.
NEJM 1995;333:573-578.
ABSTRACT | FULL TEXT  

Does 'Aggressive Approach' Equal Higher Cost?
Forwand
Arch Intern Med 1995;155:335-335.
ABSTRACT  

Does 'Aggressive Approach' Equal Higher Cost?-Reply
Pilote et al.
Arch Intern Med 1995;155:335-335.
ABSTRACT  

Use of Medical Resources and Quality of Life after Acute Myocardial Infarction in Canada and the United States
Mark et al.
NEJM 1994;331:1130-1135.
ABSTRACT | FULL TEXT