Hospital-Level Disparities in the Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction.

Autor: Patlolla SH; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota., Pajjuru VS; Division of Cardiovascular Medicine, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska., Sundaragiri PR; Department of Primary Care Internal Medicine, Wake Forest Baptist Health, High Point, North Carolina., Cheungpasitporn W; Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota., Sachdeva R; Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiovascular Medicine, Department of Medicine, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia., McDaniel MC; Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia., Kumar G; Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiovascular Medicine, Department of Medicine, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia., Rab ST; Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia., Vallabhajosyula S; Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina. Electronic address: svallabh@wakehealth.edu.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2022 Apr 15; Vol. 169, pp. 24-31. Date of Electronic Publication: 2022 Jan 19.
DOI: 10.1016/j.amjcard.2021.12.057
Abstrakt: There are limited contemporary data evaluating the relation between hospital characteristics and outcomes of patients with cardiac arrest complicating acute myocardial infarction (AMI-CA). As such, we used the National Inpatient Sample database (2000 to 2017), to identify adult admissions with primary diagnosis of AMI and concomitant CA. Interhospital transfers were excluded, and hospitals were classified based on location and teaching status (rural, urban nonteaching, and urban teaching) and bed size (small, medium, and large). Among 494,083 AMI-CA admissions, 9.3% received care at rural hospitals, 43.4% at urban nonteaching hospitals, and 47.3% at urban teaching hospitals. Compared with urban nonteaching and teaching hospitals, AMI-CA admissions at rural hospitals received lower rates of cardiac and noncardiac procedures. Admissions to urban teaching hospitals had higher rates of acute organ failure, concomitant cardiogenic shock, and cardiac and noncardiac procedures. When hospitals were stratified by bed size, 9.8% of AMI-CA admissions were admitted to small capacity hospitals, 26.0% to medium capacity, and 64.2% to large capacity hospitals. The use of cardiac and noncardiac procedures was lower in small hospitals with higher rates of use in medium and large hospitals. In-hospital mortality was higher in urban nonteaching (adjusted odds ratio [OR] 1.17; 95% confidence interval [CI]1.14 to 1.20; p <0.001) and urban teaching hospitals (adjusted OR 1.36; 95% CI 1.32 to 1.39; p <0.001) compared with rural hospitals. Compared with small hospitals, medium (adjusted OR 1.11; 95% CI 1.08 to 1.14; p <0.001) and large hospitals (adjusted OR 1.22; 95% CI 1.19 to 1.25; p <0.001) were associated with higher in-hospital mortality. In conclusion, AMI-CA admissions to large and urban hospitals had higher in-hospital mortality compared with small and rural hospitals potentially owing to greater acuity.
Competing Interests: Disclosures The authors have no conflicts of interest to declare.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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