Table 1.
Baseline Characteristics of STEMI Patients Transferred to a Different Facility After Receiving Fibrinolytic Therapy
| Overall | Medical Therapy Alone | CA Without Revascularization | CA With Revascularization | P Value | |
|---|---|---|---|---|---|
| No. of observations (%) | 18 814 (100.0) | 853 (4.5) | 2573 (13.7) | 15 388 (81.8) | |
| Patient age, y, % | <0.001 | ||||
| 18–34 | 1.1 | 0.6 | 3.9 | 0.7 | |
| 35–49 | 18.8 | 8.2 | 20.3 | 19.1 | |
| 50–64 | 44.5 | 30.5 | 40.5 | 45.9 | |
| 65–79 | 28.5 | 28.2 | 26.1 | 28.9 | |
| ≥80 | 7.2 | 32.5 | 9.1 | 5.4 | |
| Sex, % | <0.001 | ||||
| M | 73.5 | 61.3 | 66.2 | 75.4 | |
| F | 26.5 | 38.7 | 33.8 | 24.6 | |
| Race, % | <0.001 | ||||
| White | 65.9 | 67.5 | 69.0 | 65.3 | |
| Black | 3.2 | 4.7 | 4.4 | 2.9 | |
| Hispanic | 6.1 | 5.3 | 4.9 | 6.4 | |
| Other | 5.3 | 5.9 | 5.0 | 5.3 | |
| Missing | 19.5 | 16.6 | 16.7 | 20.1 | |
| Comorbidities, % | |||||
| Deyo modification of CCI scorea | <0.001 | ||||
| ≤ 1 | 53.1 | 35.2 | 49.7 | 54.6 | |
| 2 | 29.7 | 29.2 | 30.8 | 29.6 | |
| ≥ 3 | 17.2 | 35.6 | 19.4 | 15.8 | |
| Obesity | 14.7 | 9.2 | 17.3 | 14.6 | <0.001 |
| HTN | 60.0 | 63.5 | 61.0 | 59.7 | 0.045 |
| DM | 24.3 | 27.0 | 25.3 | 24.0 | 0.058 |
| CHF | 13.4 | 22.5 | 14.6 | 12.6 | <0.001 |
| COPD (Chronic Obstructive Pulmonary Disease) | 15.1 | 22.4 | 17.8 | 14.2 | <0.001 |
| PVD | 6.5 | 13.4 | 5.2 | 6.4 | <0.001 |
| Fluid‐electrolyte abnormalities and renal failure | 15.4 | 31.8 | 16.2 | 14.3 | <0.001 |
| Neurological disorder or paralysis | 3.3 | 12.6 | 4.2 | 2.6 | <0.001 |
| Anemia or coagulopathy | 9.5 | 16.7 | 8.9 | 9.2 | <0.001 |
| Solid tumors, metastatic cancers, or lymphoma | 1.1 | 1.2 | 0.8 | 1.1 | 0.220 |
| Depression, psychosis, or substance abuse | 7.4 | 7.6 | 10.8 | 6.8 | <0.001 |
| Median HHI category for patient Zip code, %b | 0.002 | ||||
| 0–25 | 42.4 | 43.7 | 42.4 | 42.3 | |
| 26–50 | 30.7 | 27.7 | 30.4 | 31.0 | |
| 51–75 | 14.3 | 17.2 | 15.8 | 13.8 | |
| 76–100 | 8.2 | 7.3 | 7.0 | 8.4 | |
| Primary payer, % | <0.001 | ||||
| Medicare/ Medicaid | 43.6 | 64.5 | 46.5 | 41.9 | |
| Private insurance (including HMOs) | 40.3 | 24.0 | 36.7 | 41.8 | |
| Other/self‐pay/no charge | 15.9 | 11.0 | 16.6 | 16.1 | |
| Hospital characteristics | |||||
| Bed size, % | 0.052 | ||||
| Small | 8.2 | 10.5 | 8.2 | 8.0 | |
| Medium | 21.6 | 20.2 | 22.6 | 21.5 | |
| Large | 69.4 | 69.3 | 67.7 | 69.7 | |
| Teaching status, % | <0.001 | ||||
| Nonteaching | 39.6 | 48.8 | 39.9 | 39.0 | |
| Teaching | 59.6 | 51.2 | 58.6 | 60.2 | |
| Region, % | <0.001 | ||||
| Northeast | 11.6 | 13.5 | 7.7 | 12.2 | |
| Midwest | 18.1 | 17.2 | 16.7 | 18.3 | |
| South | 36.0 | 32.3 | 39.7 | 35.6 | |
| West | 22.9 | 19.5 | 24.2 | 22.9 | |
| Admission day, % | 0.523 | ||||
| Weekday | 70.3 | 71.7 | 70.8 | 70.2 | |
| Weekend | 29.7 | 28.3 | 29.2 | 29.8 | |
| Disposition of survivors, % | <0.001 | ||||
| Home | 85.6 | 48.0 | 80.7 | 88.5 | |
| Transfer to short‐term hospital/other facilities/HHC | 10.3 | 29.2 | 11.52 | 9.03 | |
| Against medical advice (AMA) | 0.64 | 2.8 | 1.25 | 0.4 | |
| In‐hospital mortality, % | 3.51 | 20.0 | 6.6 | 2.1 | <0.001 |
| LOS, d, median (IQR) | 3.0 (2.0–4.0) | 3.0 (2.0–6.0) | 3.0(2.0–4.0) | 3.0 (2.0–4.0) | 0.323 |
| Adjusted cost, $, median (IQR) | 17 479 (12 912–24 619) | 7701 (3 936–14 001) | 10 892 (7868–15 461) | 18 773 (14 516–26 124) | <0.001 |
| Cardiac arrest, % | 2.9 | 6.5 | 4.2 | 2.4 | <0.001 |
| Cardiogenic shock, % | 7.4 | 16.3 | 7.7 | 6.8 | <0.001 |
| Wall involved | <0.001 | ||||
| Anterolateral | 8.5 | 12.6 | 8.5 | 8.2 | |
| Anterior | 28.9 | 33.3 | 32.5 | 28.0 | |
| Inferolateral | 8.0 | 8.3 | 6.9 | 8.1 | |
| Inferoposterior | 5.6 | 5.7 | 5.4 | 5.7 | |
| Inferior | 45.6 | 36.5 | 41.0 | 47.0 | |
| Lateral | 2.5 | 1.8 | 4.5 | 2.2 | |
| Posterior | 0.4 | 1.3 | 0.2 | 0.4 | |
| Other specified | 0.5 | 0.6 | 1.0 | 0.4 | |
| Type of stent | |||||
| ≥1 DES | 49.9 | — | — | 61.1 | |
| Only BMS | 23.5 | — | — | 28.8 |
Abbreviations: AMA, against medical advice; BMS, bare‐metal stent; CA, coronary angiography; CCI, Charlson Comorbidity Index; CHF, congestive heart failure; DES, drug‐eluting stent; DM, diabetes mellitus; F, female; HHC, home health care; HHI, household income; HMO, health maintenance organization; HTN, hypertension; Hx, history; ICD‐9‐CM, International Classification of Diseases, Ninth Revision, Clinical Modification; IQR, interquartile range; LOS, length of stay; M, male; PVD, peripheral vascular disease; STEMI, ST‐segment elevation myocardial infarction.
Charlson/Deyo Comorbidity Index was calculated as per Deyo classification. Comorbidities were identified by ICD‐9‐CM code mentioned in any of the diagnostic fields.
This represents a quartile classification of the estimated median HHI of residents in the patient's Zip code. These values are derived from Zip code demographic data obtained from Claritas. The quartiles are identified by values of 1 to 4, indicating the poorest to wealthiest populations. Because these estimates are updated annually, the value ranges vary by year (http://www.hcup‐us.ahrq.gov/db/vars/zipinc_qrtl/nisnote.jsp).