Geographic variation and temporal trends in management and outcomes of cardiac arrest complicating acute myocardial infarction in the United States
| Autor: | S. Tanveer Rab, Auras R Atreya, Saraschandra Vallabhajosyula, Sri Harsha Patlolla, Wissam Jaber, Chandan Devireddy, Spencer B. King, John S. Douglas, William J. Nicholson |
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| Rok vydání: | 2021 |
| Předmět: |
Coronary angiography
Adult medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Shock Cardiogenic Geographic variation Emergency Nursing Percutaneous Coronary Intervention medicine Humans cardiovascular diseases Myocardial infarction Hospital Mortality health care economics and organizations business.industry Health services research Percutaneous coronary intervention medicine.disease United States Heart Arrest Concomitant Emergency medicine Conventional PCI Emergency Medicine Outcomes research Cardiology and Cardiovascular Medicine business |
| Zdroj: | Resuscitation. 170 |
| ISSN: | 1873-1570 2000-2017 |
| Popis: | Limited studies have evaluated regional disparities in the care of acute myocardial infarction (AMI) patients with cardiac arrest (CA). This study sought to evaluate 18-year national trends, resource utilization, and geographical variation in outcomes in AMI-CA admissions.Using the National Inpatient Sample (2000-2017), we identified adults with AMI and concomitant CA admitted to the United States census regions of Northeast, Midwest, South, and West. Clinical outcomes of interest included in-hospital mortality, use of coronary angiography, percutaneous coronary intervention (PCI), mechanical circulatory support (MCS), hospitalization costs and length of stay. Of 9,680,257 admissions for AMI, 494,083 (5.1%) had concomitant CA. The West (6.0%) had higher prevalence compared to the Northeast (4.4%), Midwest (5.0%), and South (5.1%), p 0.001. Admissions in the West had higher rates of STEMI, cardiogenic shock, multiorgan failure, mechanical ventilation, and hemodialysis. Northeast admissions had lower use of coronary angiography (52.0% vs. 67.9% vs. 60.9% vs. 61.5%), PCI (38.7% vs. 51.9% vs. 44.8% vs. 46.7%), and MCS (18.4% vs. 21.8% vs. 18.1%, vs. 20.0%) compared to the Midwest, West and South (all p 0.001). Compared with the Northeast, adjusted in-hospital mortality was higher in the Midwest (odds ratio [OR] 1.06 [95% confidence interval {CI} 1.03-1.08]), South (OR 1.11 [95% CI 1.09-1.13]) and highest in the West (OR 1.16 [95% CI 1.13-1.18]), all p 0.001. Temporal trends showed a decline in in-hospital mortality except in the West, which showed a slight increase.There remain significant regional disparities in the management and outcomes of AMI-CA. |
| Databáze: | OpenAIRE |
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