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Diversion of ambulances associated with increased risk of death for heart-attack patients
Date:6/12/2011

. Among the outcomes measured were the percentage of patients with AMI who died within 7 days, 30 days, 90 days, 9 months, and 1 year from admission (when their nearest ED was not on diversion and when that same ED was exposed to less than 6, 6 to less than 12, and 12 or more hours of diversion out of 24 hours on the day of admission).

Between 2000 and 2006, the average daily diversion duration was 7.9 hours. The analysis included 11,625 patients, and among these patients, 3,541, 3,357, 2,667, and 2,060 were admitted for AMI when their closest ED was not exposed to diversion and was exposed to less than 6 hours, 6 to less than 12 hours, and 12 or more hours, respectively. There were 1,034 patients (29 percent) in the no diversion category who died within 1 year of ED admission, and the number of patients who died within 1 year of admission in the less than 6 hours, 6 to less than 12 hours, and 12 or more hours diversion categories were 1,028 (31 percent), 794 (30 percent), and 731 (35 percent), respectively.

There were differences in treatment patterns for patients once admitted: the number of patients receiving catheterization was 42 percent among those in the 12 hours or greater ED diversion exposure category vs. 49 percent in the no diversion category; and number of patients receiving percutaneous coronary intervention (procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries) was 24 percent in 12 hours or greater exposure category vs. 31 percent in the no diversion category.

Analysis of data indicated that there were no statistically significant differences in mortality rates between no diversion status and when the exposure to diversion was less than 12 hours. However, exposure to 12 or more hours of diversion, compared to no diversion, was associated with higher mortality rates at 30-days (19 percent vs. 15 percent); 90-days (26 percent vs. 22 percent); 9-months (33 percent vs. 28 percent); an
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Contact: Alan Richmond
abrichmo@nps.edu
831-656-3649
JAMA and Archives Journals
Source:Eurekalert

Page: 1 2 3

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