Variation in the Incidence of Hospital-Acquired Anemia During Hospitalization With Acute Myocardial Infarction (Data from 57 US Hospitals)

2014 ◽  
Vol 113 (7) ◽  
pp. 1130-1136 ◽  
Author(s):  
Adam C. Salisbury ◽  
Kimberly J. Reid ◽  
Amit P. Amin ◽  
John A. Spertus ◽  
Mikhail Kosiborod
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Acquired

Abstract P73: Comparison of Hospital-Acquired Anemia and TIMI Bleeding for Mortality Prediction in Patients with Acute Myocardial Infarction

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Adam C Salisbury ◽  
Amit P Amin ◽  
Karen P Alexander ◽  
Frederick A Masoudi ◽  
Yan Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
At Risk ◽  
Assessment Tool ◽  
Mortality Prediction ◽  
Logistic Regression Models ◽  
Net Reclassification Improvement ◽  
Risk Patients ◽  
Poor Outcomes ◽  
Hospital Acquired

Background: In-hospital bleeding and new onset, hospital acquired anemia (HAA) are both associated with higher mortality in acute myocardial infarction (AMI). Since bleeding is variably defined and often poorly documented, HAA could be a better method to identify at-risk patients, if its prognostic ability were at least as good as documented bleeding. We directly compared the association of HAA and TIMI bleeding with 1-year mortality. Methods: Among 2,803 AMI patients who were not anemic at admission in the 24-center TRIUMPH registry, the presence and severity of HAA and TIMI bleeding were prospectively collected to identify their relative discrimination of 1-year mortality. Logistic regression models, accounting for clustering using generalized estimating equations, were fit for 1) no bleeding, TIMI minimal, minor and major bleeding and 2) no HAA, mild (hemoglobin (Hgb) > 11 g/dl), moderate (Hgb 9 - 11 g/dl) and severe HAA (Hgb < 9 g/dl). Discrimination was compared using c-statistics and reclassification was assessed using the integrated discrimination improvement (IDI), which measures a model's improvement in average sensitivity without sacrificing average specificity vs. another model, and the continuous net reclassification improvement (NRI), to identify the proportion of patients correctly reclassified by the HAA model. Results: HAA was more common (mild: 33%, moderate: 10%, severe 2%) than TIMI bleeding (minimal: 5%, minor: 3%, major 1%). Over 1-year follow-up, 111 patients (4%) died. The HAA model was superior to TIMI bleeding model for 1-year mortality prediction (c-statistic 0.60 vs. 0.51, p<0.001). The IDI of the HAA vs. the bleeding model was 0.009 (95% CI 0.005 - 0.014) and the relative IDI was 0.26 (26% better average discrimination), with a NRI of 0.32 (0.13-0.50) - 17% of patients with events were correctly reclassified to a higher risk while 14% of patients without events were correctly reclassified to a lower risk by the HAA model. Conclusions: HAA is better than TIMI bleeding for identifying 1-year mortality after AMI hospitalization, and may better identify patients without recognized bleeding who are also at risk for poor outcomes. HAA may be useful to identify high-risk patients and as a quality assessment tool.

scholarly journals Incidence, Correlates, and Outcomes of Acute, Hospital-Acquired Anemia in Patients With Acute Myocardial Infarction

2010 ◽  
Vol 3 (4) ◽  
pp. 337-346 ◽  
Author(s):  
Adam C. Salisbury ◽  
Karen P. Alexander ◽  
Kimberly J. Reid ◽  
Frederick A. Masoudi ◽  
Saif S. Rathore ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Hospital ◽  
Hospital Acquired

scholarly journals Recovery From Hospital-Acquired Anemia After Acute Myocardial Infarction and Effect on Outcomes

2011 ◽  
Vol 108 (7) ◽  
pp. 949-954 ◽  
Author(s):  
Adam C. Salisbury ◽  
Mikhail Kosiborod ◽  
Amit P. Amin ◽  
Kimberly J. Reid ◽  
Karen P. Alexander ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Acquired

Impact of In-Hospital Acquired Thrombocytopenia in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

2005 ◽  
Vol 96 (4) ◽  
pp. 474-481 ◽  
Author(s):  
Eugenia Nikolsky ◽  
H. Mehrdad Sadeghi ◽  
Mark B. Effron ◽  
Roxana Mehran ◽  
Alexandra J. Lansky ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Primary Angioplasty ◽  
Hospital Acquired

Abstract P106: Variation in the Incidence of Hospital-Acquired Anemia During Admission with Acute Myocardial Infarction Across 57 US Hospitals

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Adam C Salisbury ◽  
Karen P Alexander ◽  
Kimberly J Reid ◽  
Frederick A Masoudi ◽  
John A Spertus ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Teaching Hospitals ◽  
Site Factors ◽  
Processes Of Care ◽  
Hospital Variation ◽  
Teaching Status ◽  
Rate Ratios ◽  
Hospital Acquired ◽  
Hospital Characteristics

Background: New onset, hospital-acquired anemia (HAA) during acute myocardial infarction (AMI) may be related to hospital-based processes of care. HAA is associated with poor outcomes, but little is known about the extent of hospital variation in the incidence of HAA or the hospital characteristics associated with HAA. Methods: We studied 17,676 AMI patients not anemic at admission, defining moderate-severe HAA as a hemoglobin decline to < 11 g/dl. Shrinkage estimates of moderate-severe HAA incidence were generated to account for low volume sites. Multivariable models were used to identify adjusted variation in moderate-severe HAA across hospitals, using median rate ratios (MRR - median value of the relative risk of moderate-severe HAA for two identical patients presenting to two randomly selected hospitals) and fit a separate model to test the association between hospital characteristics (# beds, region, urban/rural, teaching status) and moderate-severe HAA adjusting for patient factors. Results: Overall, 3,551 (20%) developed moderate-severe HAA. The incidence of moderate-severe HAA varied substantially across sites (Figure) and was significant after multivariable adjustment (MRR 1.3 [1.2-1.4]). The only site factors independently associated with moderate-severe HAA were teaching status (RR 0.7 [0.6-0.9] vs. non-teaching) and region (South vs. Midwest: RR 1.3 [1.0-1.5]). Conclusions: We found significant variation in the incidence of moderate-severe HAA and a lower risk of HAA in teaching hospitals. Further study of the relationship between HAA and specific processes of care is needed to identify actionable targets for quality improvement.

Red Blood Cell Indices and Development of Hospital-Acquired Anemia During Acute Myocardial Infarction

2012 ◽  
Vol 109 (8) ◽  
pp. 1104-1110 ◽  
Author(s):  
Adam C. Salisbury ◽  
Amit P. Amin ◽  
Kimberly J. Reid ◽  
Tracy Y. Wang ◽  
Karen P. Alexander ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Red Blood Cell Indices ◽  
Hospital Acquired

scholarly journals DIAGNOSTIC BLOOD LOSS IS ASSOCIATED WITH DEVELOPMENT OF HOSPITAL-ACQUIRED ANEMIA DURING ADMISSION WITH ACUTE MYOCARDIAL INFARCTION

2011 ◽  
Vol 57 (14) ◽  
pp. E1172
Author(s):  
Adam C. Salisbury ◽  
Kimberly J. Reid ◽  
Paul S. Chan ◽  
Frederick A. Masoudi ◽  
Karen P. Alexander ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Blood Loss ◽  
Hospital Acquired

scholarly journals RED BLOOD CELL INDICES AND DEVELOPMENT OF HOSPITAL-ACQUIRED ANEMIA DURING ACUTE MYOCARDIAL INFARCTION

2012 ◽  
Vol 59 (13) ◽  
pp. E1815 ◽  
Author(s):  
Adam C. Salisbury ◽  
Amit Amin ◽  
Kimberly Reid ◽  
Tracy Wang ◽  
Karen Alexander ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Red Blood Cell Indices ◽  
Hospital Acquired

Hospital-acquired anemia and in-hospital mortality in patients with acute myocardial infarction

2011 ◽  
Vol 162 (2) ◽  
pp. 300-309.e3 ◽  
Author(s):  
Adam C. Salisbury ◽  
Amit P. Amin ◽  
Kimberly J. Reid ◽  
Tracy Y. Wang ◽  
Frederick A. Masoudi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Hospital Acquired
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