Effectiveness of coronary care units in small community hospitals.

A prospective study was undertaken from 1969 to 1974 to evaluate a program establishing coronary care units in small community hospitals. Crude mortality rates from acute myocardial infarction in these small hospitals were 14.5%, slightly higher but not statistically different from concurrently collected data in three larger comparision hospitals (11.5%). Mutivariate discriminate analysis of clinical characteristics was used to calculate a risk score for each patient admitted. Observed deaths exceeded expected deaths (134 versus 119) (P greater than 0.30) in small hospitals but observed deaths were less than expected (55 versus 77)(P less than 0.05) in comparison hospitals. Mortality was significantly greater in those units admitting fewer than 60 patients with infarctions yearly (20.9%) than in those admitting more than 60 (10.7%) (P less than 0.001). These data suggest that coronary care units in small community hospitals can provide adequate coronary care, but their level of performance drops when fewer than 60 patients with infarctions are admitted yearly.