While various community and hospital characteristics have been demonstrated to have an impact on individual cardiovascular outcomes, the extent to which such factors account for inter-regional and interhospital outcome variations following acute myocardial infarction (AMI) remains unknown.
To examine the impact of community and hospital factors on individual AMI outcomes and procedure use, and to determine the extent to which such characteristics account for inter-regional and interinstitutional AMI outcome and procedure variations across Canada.
Patients hospitalized with AMI between April 1, 1997, and March 31, 2000, across Canada were examined. The community and hospital characteristics studied included three indicators of socioeconomic status, two indicators of ethnicity, rural-urban status of residence, hospital academic affiliation, and the presence or absence of on-site angiography or revascularization capabilities at the admitting institution. Outcomes included in-hospital mortality, one-year cardiac readmissions and 30-day revascularization rates post-AMI. All analyses were adjusted for age, sex and age-sex interaction. The relationships between community/hospital factors and individual outcomes were examined using random-effects hierarchical logistic regression analysis, while the relationships between community/hospital characteristics and inter-regional/hospital risk-adjusted outcomes were examined using least squares regression and the coefficient of determination (r2).
After adjusting for demographic factors, a patient's neighbourhood socioeconomic status was inversely correlated with the likelihood of death and downstream cardiac readmissions (P