Association between time of hospitalization with acute myocardial infarction and in-hospital mortality
| Autor: | Peter Ludman, Chris Wilkinson, Jianhua Wu, Marlous Hall, Mark deBelder, Adam Timmis, Keith A.A. Fox, Chris P Gale, Tatendashe B Dondo |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Myocardial Infarction Comorbidity 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Case mix index Internal medicine Outcome Assessment Health Care medicine Humans Hospital Mortality Myocardial infarction Non-ST Elevated Myocardial Infarction Clinical treatment Aged Aged 80 and over Wales In hospital mortality business.industry Outcome measures 030229 sport sciences Odds ratio Middle Aged medicine.disease Hospitalization England Acute Disease Propensity score matching ST Elevation Myocardial Infarction Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Heart Journal. 40:1214-1221 |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehy835 |
| Popis: | Aim: To study the association between time of hospitalization and in-hospital mortality for acute myocardial infarction (AMI). Methods and Results: Patients admitted with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) across 243 hospitals in England and Wales between 1st January 2004 and 31st March 2013 were included. The outcome measure was in-hospital mortality. Adjusted odds ratios for in-hospital mortality were estimated across six four-hourly time periods over the 24-hour clock using multilevel logistic regression, inverse-probability weighting propensity score and instrumental variable analysis. Among 615,035 patients (median age 70.0 years, IQR 59.0 - 80.0 years; 406,519 (66.0%) men), there were 52,777 (8.8%) in-hospital deaths. At night, patients with NSTEMI were more frequently co-morbid, and for STEMI had longer symptom-onset-to-reperfusion times. For STEMI, unadjusted in-hospital mortality was highest between 20:00 and 23:59 (four-hour period range 8.4% to 9.9%; OR compared with 00:00 to 03:59 reference 1.13, 95% CI 1.07 to 1.20), and for NSTEMI highest between 12:00 to 15:59 (8.0% to 8.8%; OR compared with 00:00 to 03:59 reference 1.07, 95% CI 1.03 to 1.12). However, these differences were only apparent in the earlier years of the study, and were attenuated by adjustment for demographics, co-morbidities and clinical presentation. Differences were not statistically significant after adjustment for acute clinical treatment provided. Conclusions: There is little evidence to support an association between time of hospitalization and in-hospital mortality for acute myocardial infarction; variation in in-hospital mortality may be explained by case mix and the use of treatments. |
| Databáze: | OpenAIRE |
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