Differences in management of heart attack patients between metropolitan and regional hospitals in the Hunter Region of Australia

Objectives: To test the hypothesis that among patients with acute myocardial infarction (AMI) length of hospital stay, drug use in hospital and on discharge were different between metropolitan and regional hospitals after adjusting for differences in patient baseline risk. Methods: A retrospective cohort study using a community-based register of heart attack patients assessed 1,406 patients admitted for definite AMI to three metropolitan and five regional hospitals in the Lower Hunter Region of NSW, between January 1, 1990, and March 31, 1994. Results: Patients in metropolitan hospitals were significantly less likely to stay in hospital for more than seven days (adjusted odds ratio=0.50; 95% CI 0.34-0.73), significantly more likely to receive ACE inhibitors (adj.OR=1.47; 1.27-1.71) and less likely to receive calcium channel blocker (adj.OR=0.70; 0.54-0.98). Regardless of disease severity, metropolitan hospitals had a higher percentage of patients for whom drugs shown to decrease mortality after AMI were used (streptokinase, aspirin, ACE inhibitor); a lower percentage of patients received drugs shown to have no benefit or even a detrimental effect (calcium channel blocker). Both groups had relatively low use of beta blocker, also shown to be of benefit. Conclusions: Regional hospitals had longer hospital stays than metropolitan hospitals and less use of drugs of proven benefit.