Download this article's Factoid (PDF & PPT for Gold Subscribers) 

STEMI patients who require an emergent transfer for PCI generally understand the situation and accept the need to transfer, but a significant minority would prefer to stay at a local hospital, according to a study published online March 4, 2014, ahead of print in Circulation: Cardiovascular Quality and Outcomes. The study, using data from the Minneapolis Heart Institute’s Regional STEMI program, suggests that informing and educating patients is feasible even in emergency situations.

Researchers led by Timothy D. Henry, MD, of the Minneapolis Heart Institute Foundation (Minneapolis, MN), conducted a patient satisfaction survey of 152 patients—and their families—who survived to discharge following PCI for STEMI that required a transfer. The survey response rate was 65.8%, with 98 patients included in the final analysis.

The majority of patients responded that the reasons for transfer and the process of transfer were well explained, and almost all acknowledged that the need for transfer was necessary; still, some would have preferred to avoid the transfer (Table 1).

Table 1. STEMI Patient Satisfaction After Transfer for PCI

There were some differences between the groups who preferred to stay at their local hospital and those who preferred the transfer. Those who preferred to stay were more likely to have a history of smoking (86.7% vs 61.5%; P = 0.059) and to be retired (86.7% vs 38.6%; P = 0.001). Unsurprisingly, patients who preferred to transfer were slightly more likely to be aware of the reason for transfer and said that the transfer process was explained to them, though these differences did not reach statistical significance.

The investigators described the results of the survey given to family members as “favorable overall.” Most felt that they were given appropriate direction on how to join their family member at the PCI hospital (92%), and the transfer process (88%) and patient’s condition (94%) were explained in a way they could understand. Though 15% of the patients themselves said they would have preferred to stay at a local hospital, 11% of family respondents preferred that option.

Satisfaction or Right to Choose?

In a phone interview, Dr. Henry told TCTMD that one of the primary take-home messages from this study is simply that collecting this type of patient satisfaction data is feasible. It is particularly of interest, he said, in regional health systems where transfers for PCI and other procedures are commonplace. The respondents in this study also shed some light on why they might have preferred to avoid transfer; these reasons included financial difficulties and the effect on their families if an extended stay away from home was needed.

Edward L. Hannan, PhD, of the University at Albany, State University of New York (Albany, NY), stated in an email that this is more a question of a patient’s right to choose than simply of patient satisfaction. “The catch is how to give patients the information they need to know to make an informed choice, particularly when they are in the midst of a STEMI,” he said.

Dr. Hannan added that among the most important information for patients and families is the expected probability of adverse outcomes with and without PCI. “When patients are asked after they have had a successful PCI whether they would have preferred not to have been transferred, do they really understand that the outcome may not have been successful if they had not been transferred?”

The study authors did note that these results included only patients from rural and community hospitals in Minnesota, and they may not reflect opinions in other settings. Socioeconomic and psychological differences between the groups were not measured.

Henry JT, Christiansen E, Garberich RF, et al. Satisfaction with emergent transfer for percutaneous coronary interventions on patients with ST-segment elevation myocardial infarction and their families. Circ Cardiovasc Qual Outcomes. 2014;Epub ahead of print.

Related Stories:

• Thrombolysis with Immediate Transfer for PCI Safe for Rural STEMI Patients
• Registry Finds Prehospital Fibrinolysis Suitable for Low-Risk STEMI Patients
• Primary PCI Reduces Symptoms vs. Fibrinolysis 5 Years After STEMI