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

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 prima...

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Bibliographic Details
Published in:The American journal of cardiology 2022-04, Vol.169, p.24-31
Main Authors: Patlolla, Sri Harsha, Pajjuru, Venkata S., Sundaragiri, Pranathi R., Cheungpasitporn, Wisit, Sachdeva, Rajesh, McDaniel, Michael C., Kumar, Gautam, Rab, S. Tanveer, Vallabhajosyula, Saraschandra
Format: Article
Language:English
Subjects:
Acuity
Adult
Cardiac arrest
Confidence intervals
Heart
Heart Arrest - complications
Heart Arrest - epidemiology
Heart Arrest - therapy
Heart attacks
Hospital Mortality
Hospitals
Hospitals, Urban
Humans
Medical imaging
Mortality
Myocardial infarction
Myocardial Infarction - complications
Myocardial Infarction - epidemiology
Myocardial Infarction - therapy
Patients
Pulmonary arteries
Regression analysis
Rural areas
Rural health care
Shock, Cardiogenic - etiology
Socioeconomic factors
Teaching hospitals
Trends
United States - epidemiology
Urban areas
Urban health care
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Summary: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
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2021.12.057