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Impact on mortality following first acute myocardial infarction of distance between home and hospital: Cohort study
  1. Li Wei (l.wei{at}dundee.ac.uk)
  1. Medicines Monitoring Unit, United Kingdom
    1. Chim C Lang
    1. Ninewells Hospital and Medical School, United Kingdom
      1. Frank M Sullivan
      1. University of Dundee, United Kingdom
        1. Paul Boyle
        1. Univeristy of St Andrews, United Kingdom
          1. Jixian Wang
          1. University of Dundee, United Kingdom
            1. Stuart Pringle
            1. Ninewells Hospital and Medical School, United Kingdom
              1. Thomas M MacDonald (t.m.macdonald{at}dundee.ac.uk)
              1. University of Dundee, United Kingdom

                Abstract

                Objective To investigate the effect of distance between home and acute hospital on mortality outcome of patients experiencing an incident myocardial infarction (MI).

                Design Cohort study using a record linkage database.

                Setting Tayside, Scotland, UK.

                Patients 10,541 patients with incident acute MI between 1994 and 2003 were identified from Tayside hospital discharge data and from death certification data.

                Main outcome measures MI mortality in the community, all-cause mortality in hospital and all-cause mortality.

                Results 4,133 subjects died following incident MI in the community (i.e. were not hospitalised), 6,408 patients survived to be hospitalised and 1,010 of these (15.8%) died in hospital. Of 5,398 discharged from hospital, 1,907 (35.3%) died during a median of 3.2 years of follow-up. After adjustment for rurality and other known risk factors, distance between home and admitting hospital was significantly associated with increased mortality both prior to hospital admission (adjusted OR, 2.05, 95% CI 1.00-4.21 for >9 miles and 1.46, 1.09-1.95 for 3-9 miles when compared to <3 miles) and after hospitalisation (adjusted HR 1.90, 1.19-3.02 and 1.27 0.96-1.68). However, there was no effect of distance on in-hospital mortality (adjusted OR 0.95, 0.45-2.03 and 1.02 0.66-1.58).

                Conclusions The distance between home and hospital of admission may predict mortality in subjects experiencing a first acute MI. This association was found both prior to hospital and following hospitalisation. Further studies are needed to explore the reasons for this association. However these data provide support for policies which locate services for acute MI closer to where patients live.

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