AHA: Community hospitals may outperform academic centers for EP care

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Community centers may see better outcomes than care provided at academic centers in terms of providing electrophysiology care to an older, sicker patient population, according to a study presented at the American Heart Association’s (AHA) Quality of Care and Outcomes Research in Cardiovascular Disease and Stoke 2010 scientific sessions May 21.

Jeffrey L. Williams, MD, of the Lebanon Cardiology Associates in Lebanon, Pa., and colleagues conducted a study on the EP program at the Good Samaritan Hospital, a non-academic hospital in Lebanon, Pa., to assess demographic and complication rates of 250 pacemaker and defibrillator patients.

“There is a perception (yet very little substantive data) that community hospitals cherry-pick less ill patients from higher-performing academic centers,” said Williams.

Results showed that 4.4 percent of the patients were readmitted six weeks after implant; four of these 11 cases (36.4 percent) were not device related.

Additionally, the researchers found that major and minor complications occurred at a rate of 0.4 and 3.1 percent, respectively.

Statistics of complication rates were lower than those reported in national trials and academic centers, the researchers found.

Results showed that compared to the MADIT-CRT trial, rates of minor complications at Good Samaritan Hospital were significantly lower, 8.4 percent versus 3.1 percent, respectively.

Additionally, the rate of major complications was lower at Good Samaritan compared to the national trials at academic centers. The MADIT-CRT trial showed a major complication rate of 2.2 percent while the COMPANION trial showed a major complication rate of 3.4 percent.

According to the researchers, patients in the community hospital arm were seven to 10 years older than patients who presented for the national trial in academic centers and had worse kidney function.

According to Williams, if complications from defibrillator implants were reduced by 75 percent, the U.S. would realize an estimated cost savings of more than $60 million.

“Highly performing 'niche' hospitals such as Good Samaritan may offer improved quality care while reducing costs of pacemaker and defibrillator implantation,” the authors concluded.