Invasive management and in-hospital outcomes of myocardial infarction patients in United States safety-net hospitals
Invasive management and in-hospital outcomes of myocardial infarction patients in United States safety-net hospitals
Aim: safety-net hospitals (SNHs) look after a higher proportion of uninsured patients and are often located in deprived areas. This study aimed to determine whether there are differences in the clinical characteristics, treatments and outcomes of patients presenting with acute myocardial infarction (AMI) in SNHs versus non-SNHs (N-SNHs).
Methods: all hospitalizations with a principal diagnosis of AMI in the United States' National Inpatient Sample between 2016 and 2019 were stratified by safety-net hospital status. Multivariable logistic regression with adjusted odds ratios (aOR) and 95 % confidence intervals (95 % CI) was conducted to investigate invasive management and clinical outcomes.
Results: a total of 2,544,009 weighted discharge records were analyzed, including 601,719 records from SNHs (23.7 %). Compared with N-SNHs, SNH AMI patients were younger (median 66 years vs. 67 years, p < 0.001), and had a higher proportion in the lowest quartile of median household income (37.3 % vs. 28.5 %, p < 0.001). Patients from SNHs were less likely to receive coronary angiography (aOR 0.92, 95 % CI 0.91–0.93, p < 0.001), percutaneous coronary intervention (aOR 0.94, 95 % CI 0.93–0.95, p < 0.001), and coronary artery bypass grafting (aOR 0.93, 95 % CI 0.92–0.94, p < 0.001). In addition, they had increased all-cause mortality (aOR 1.11, 95 % CI 1.09–1.12, p < 0.001), major adverse cardiovascular/cerebrovascular events (composite of mortality, stroke and reinfarction) (aOR 1.11, 95 % CI 1.09–1.12, p < 0.001), and stroke (aOR 1.11, 95 % CI 1.08–1.14, p < 0.001), while there was no difference in major bleeding (aOR 1.02, 95 % CI 1.00–1.04, p = 0.107).
Conclusion: among AMI patients, treatment in SNHs was associated with lower utilization of coronary angiography and revascularization and worse clinical outcomes.
7-12
Bashar, Hussein
b65209ba-c909-4e36-bbbb-568eb9bd17c7
Bharadwaj, Aditya
d9685441-51b6-4f3a-ac2b-49cc1a2d87fa
Matetić, Andrija
495d2091-cf01-4a3e-b6d2-3381ef3b25a8
Ullah, Waqas
623bb2d2-b74f-46ca-bf12-e51108684dfc
Beasley, Dorian L.
4f9ce517-9ab9-4fb1-a2f7-cd34f6f09bb0
Bullock-Palmer, Renee P.
4ee9e363-201f-4e76-a9c9-37dc996f8ca5
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Mamas, Mamas A.
f242959b-aa00-4234-831e-2d7b4e7a0ead
15 March 2023
Bashar, Hussein
b65209ba-c909-4e36-bbbb-568eb9bd17c7
Bharadwaj, Aditya
d9685441-51b6-4f3a-ac2b-49cc1a2d87fa
Matetić, Andrija
495d2091-cf01-4a3e-b6d2-3381ef3b25a8
Ullah, Waqas
623bb2d2-b74f-46ca-bf12-e51108684dfc
Beasley, Dorian L.
4f9ce517-9ab9-4fb1-a2f7-cd34f6f09bb0
Bullock-Palmer, Renee P.
4ee9e363-201f-4e76-a9c9-37dc996f8ca5
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Mamas, Mamas A.
f242959b-aa00-4234-831e-2d7b4e7a0ead
Bashar, Hussein, Bharadwaj, Aditya, Matetić, Andrija, Ullah, Waqas, Beasley, Dorian L., Bullock-Palmer, Renee P., Curzen, Nick and Mamas, Mamas A.
(2023)
Invasive management and in-hospital outcomes of myocardial infarction patients in United States safety-net hospitals.
Cardiovascular Revascularization Medicine, 49, .
(doi:10.1016/j.carrev.2022.11.006).
Abstract
Aim: safety-net hospitals (SNHs) look after a higher proportion of uninsured patients and are often located in deprived areas. This study aimed to determine whether there are differences in the clinical characteristics, treatments and outcomes of patients presenting with acute myocardial infarction (AMI) in SNHs versus non-SNHs (N-SNHs).
Methods: all hospitalizations with a principal diagnosis of AMI in the United States' National Inpatient Sample between 2016 and 2019 were stratified by safety-net hospital status. Multivariable logistic regression with adjusted odds ratios (aOR) and 95 % confidence intervals (95 % CI) was conducted to investigate invasive management and clinical outcomes.
Results: a total of 2,544,009 weighted discharge records were analyzed, including 601,719 records from SNHs (23.7 %). Compared with N-SNHs, SNH AMI patients were younger (median 66 years vs. 67 years, p < 0.001), and had a higher proportion in the lowest quartile of median household income (37.3 % vs. 28.5 %, p < 0.001). Patients from SNHs were less likely to receive coronary angiography (aOR 0.92, 95 % CI 0.91–0.93, p < 0.001), percutaneous coronary intervention (aOR 0.94, 95 % CI 0.93–0.95, p < 0.001), and coronary artery bypass grafting (aOR 0.93, 95 % CI 0.92–0.94, p < 0.001). In addition, they had increased all-cause mortality (aOR 1.11, 95 % CI 1.09–1.12, p < 0.001), major adverse cardiovascular/cerebrovascular events (composite of mortality, stroke and reinfarction) (aOR 1.11, 95 % CI 1.09–1.12, p < 0.001), and stroke (aOR 1.11, 95 % CI 1.08–1.14, p < 0.001), while there was no difference in major bleeding (aOR 1.02, 95 % CI 1.00–1.04, p = 0.107).
Conclusion: among AMI patients, treatment in SNHs was associated with lower utilization of coronary angiography and revascularization and worse clinical outcomes.
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Accepted/In Press date: 9 November 2022
e-pub ahead of print date: 18 November 2022
Published date: 15 March 2023
Additional Information:
Invasive Management and In-Hospital Outcomes of Myocardial Infarction Patients in United States Safety-Net Hospitals. Bashar H, Bharadwaj A, Matetić A, Ullah W, Beasley DL, Bullock-Palmer RP, Curzen N, Mamas MA. Cardiovasc Revasc Med. 2023 Apr;49:7-12. doi: 10.1016/j.carrev.2022.11.006. Epub 2022 Nov 18.PMID: 36411236
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Local EPrints ID: 492095
URI: http://eprints.soton.ac.uk/id/eprint/492095
ISSN: 1553-8389
PURE UUID: 8016a36d-d366-42f2-97b4-ec86126a9c7e
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Date deposited: 16 Jul 2024 16:54
Last modified: 17 Jul 2024 01:40
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Author:
Hussein Bashar
Author:
Aditya Bharadwaj
Author:
Andrija Matetić
Author:
Waqas Ullah
Author:
Dorian L. Beasley
Author:
Renee P. Bullock-Palmer
Author:
Mamas A. Mamas
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