scholarly journals Gender Disparities in Procedure Use for Acute Myocardial Infarction in the United States, 1995-1997

Circulation ◽  
2001 ◽  
Vol 103 (suppl_1) ◽  
pp. 1351-1351
Author(s):  
Alain G Bertoni ◽  
Frederick L Brancati
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Nationwide Inpatient Sample ◽  
Artery Bypass ◽  
The United States ◽  
Gender Disparity ◽  
Gender Disparities ◽  
Cross Sectional ◽  
Icd9 Code ◽  
Recent Trends

P03 Gender disparities in procedure use for acute myocardial infarction (AMI) have been well documented in selected populations in the 1980s and early 90s. However, little is known about recent trends in disparities in the general population. Therefore we conducted a series of cross-sectional analyses of data from the Nationwide Inpatient Sample for years 1995 through 1997 to compare rates of catheterization, angioplasty and coronary artery bypass grafting (CABG) performed prior to discharge for acute myocardial infarction in men vs. women. The NIS includes data (including demographics, diagnoses and procedures) on all discharges from over 900 representative civilian hospitals in 22 states. We identified 425,236 discharges with AMI (ICD9 code 410) as the first listed diagnosis during 1995-97. The cohort was 39% female (mean age 71.7) and 61% male (mean age 64.4). From 1995 to 97, catheterization rates increased in women (38.8% to 41.8%)and men (49.7% to 52.4%) as did rates of angioplasty (women 17.1% to 19.9%, men 23.0% to 26.6%) and CABG (women 8.3% to 8.7%, men 11.9% to 12.4%) After adjusting for age, race, and comorbidities, women were less than men to undergo catheterization in 1995 (odds ratio [OR] 0.85, 95% confidence interval [CI] 0.83-0.87), 1996 (OR 0.85, 95%CI 0.83-0.87), and 1997 (OR 0.87 95%CI 0.85-0.87). This gender disparity was even greater among adults aged 65 and older (adjusted OR 0.70, 95%CI 0.68-0.72 in 1995 and 96; and 0.71, 95%CI 0.69-0.72 in 1997). Women were also less likely to undergo CABG (adjusted OR 0.72, 95%CI 0.70-0.74 in 1995, 96 and 97). Among patients who underwent catheterization, women remained less likely to go on to CABG than men (adjusted OR 0.77, 95%CI 0.75-0.79). In contrast,women were only slightly less likely to undergo angioplasty (adjusted OR 0.93, 95%CI 0.91-0.94) and, once catheterized, were actually more likely to go on to angioplasty (adjusted OR 1.03, 95%CI 1.01-1.05). While procedure use for AMI is rising for men and women, these recent nationwide data suggest that women remain much less likely to undergo catheterization or CABG, but about equally likely to undergo angioplasty.

P4632Impact of intracardiac thrombosis in patients with acute myocardial infarction: insights from nationwide inpatient sample in the United States

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Dayanand ◽  
A Amanullah ◽  
J Martinez Castellanos ◽  
A Goyal ◽  
C Jeannette ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Length Of Stay ◽  
Nationwide Inpatient Sample ◽  
Artery Bypass ◽  
The United States ◽  
Primary Diagnosis ◽  
Reduced Ejection Fraction ◽  
The Impact ◽  
Intracardiac Thrombosis

Abstract Background Intracardiac thrombosis (ICT) is a complication of Acute myocardial infarction (AMI). Hypothesis Our aim was to evaluate the impact of ICT on mortality, thromboembolism, length of stay in patients with AMI. Methods Data was collected from the Nationwide Inpatient Sample (NIS) for the year 2016, where patients with a primary diagnosis of ICT as a complication of AMI (ICD10-CM code I23.6) were included. Comparisons were made between patients with ICT post-AMI (ICD10-CM code I23.6) vs those with AMI (ICD10-CM I21.0). Results Of a total of 200930 cases of AMI, 488 (0.5%) had ICT. The patients with ICT had an increased length of stay (LOS) (8.5±9.8 vs 5.7±7.4 days; p<0.001), increased ischemic stroke (10.6% vs 2.9%; p<0.001), and cardiogenic shock (15% vs 7%; p<0.001). There was no difference in mortality between the groups. Table 1. Patient characteristics AMI% (n=200,930) ICT post AMI% (n=488) p-values Demographic variables   a. Males 59 73   b. Females 41 27 <0.001 Race   a. Caucasian 71 68 0.10   b. African American 11 15 0.01   c. Hispanic 7.5 6.1 0.23   d. Other races 5.6 6.2 0.80   e. Race not specified 4.4 4.9 0.59 Comorbidities   Drug abuse 23.9 31.1 <0.001   Atrial Arrhythmias 33.1 41.6 <0.001   Ventricular Arrhythmias 5.6 9.2 <0.001   Chronic pulmonary disease 27.7 21.1 <0.001   Diabetes Mellitus 38.9 31.1 <0.001   Hypertension 81.2 70.2 <0.001   Peripheral Vascular disease 10.5 3.52 <0.001   Current or past smoker 20.5 26.1 <0.001   Chronic kidney disease 28.1 20.4 <0.001   History of coronary artery bypass surgery 10.6 5.9 <0.001   HFrEF 23.3 50 <0.001 HFrEF = Heart failure with reduced ejection fraction; pVAD = Percutaneous ventricular assist device. Conclusion ICT as a complication of AMI is associated with increased hospital LOS and adverse events.

Abstract 123: A Comparison of In-Hospital Acute Myocardial Infarction Management Between Portugal and the United States: 2000 - 2010

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Mariana F Lobo ◽  
Vanessa Azzone ◽  
Luis Azevedo ◽  
Armando Teixeira-Pinto ◽  
Jose Pereira Miguel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
The United States ◽  
Billing Data ◽  
Cross Sectional ◽  
Medical Technologies ◽  
Hospitalization Rates ◽  
The Us ◽  
International Comparative

Objectives: Because inter- and intra-country variations in the adoption of medical technologies exist, international comparative studies provide an opportunity to infer technology effectiveness. Few studies have characterized recent trends in acute myocardial infarction (AMI) management between countries. Methods: Repeated cross-sectional observational cohorts of hospitalized adults aged ≥20 years discharged between January 2000 and December 2010. We identified new AMI hospitalizations using a US national 20% inpatient sample and a 100% inpatient sample in all Portuguese public sector hospitals. Age, sex, comorbidities, and median length of stay (interquartile range [IQR]) were determined. Annual age-sex adjusted hospitalization rates (HR) for AMI, in-hospital procedures, and in-hospital mortality were directly standardized to the 2010 US population. Intra-country (2010 relative to 2000) and inter-country in 2010 (Portugal [PT] relative to US) rate ratios [RR] were estimated. Findings: We identified 1476808 AMI US hospitalizations and 126314 Portugal hospitalizations between 2000 and 2010. Portuguese patients were more male, younger, and had fewer comorbidities compared to US patients (Table). The age-sex adjusted AMI HR decreased from 21 per 1000 person-years to 15 in the US (RR=0.70; 95% CI = [0.70, 0.71]) but increased in PT (14 to 15 per 1000, RR = 1.17 [1.14, 1.21]). While crude procedure rates were uniformly lower in PT, only CABG rates differed after standardization (2010: RR=0.19 [0.14, 0.26]). PCI use increased annually in both countries and decreased for CABG in the US only (102 to 79, RR=0.77 [0.73, 0.81]). Standardized in-hospital mortality decreased within-country (US: 44 to 29 per 1000, RR= 0.65 [0.60, 0.72]; PT: 93 to 62 per 1000, RR= 0.67 [0.44, 1.00]). In 2010, PT mortality was twice that in the US. Conclusions: AMI hospitalization rates and use of medical technologies are higher in the US compared to Portugal. However, standardized rates reveal only CABG surgery rates differ significantly between the two countries. Outcomes, measured by hospital mortality and LOS, are generally better in the U.S. Inter-country disparities may be a consequence of differential use of technologies, differences in AMI epidemiology, patient risk, or quality of hospital billing data.

scholarly journals National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015

2020 ◽  
Vol 9 (20) ◽  
Author(s):  
Akshay Pendyal ◽  
Craig Rothenberg ◽  
Jean E. Scofi ◽  
Harlan M. Krumholz ◽  
Basmah Safdar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Length Of Stay ◽  
Real World ◽  
The United States ◽  
Emergency Department Care ◽  
Care Processes ◽  
Ed Visits

Background Despite investments to improve quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real‐world trends in AMI care in the emergency department (ED). We aimed to describe trends in the epidemiology and quality of AMI care in US EDs over a recent 11‐year period, from 2005 to 2015. Methods and Results We conducted an observational study of ED visits for AMI using the National Hospital Ambulatory Medical Care Survey, a nationally representative probability sample of US EDs. AMI visits were classified as ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI. Outcomes included annual incidence of AMI, median ED length of stay, ED disposition type, and ED administration of evidence‐based medications. Annual ED visits for AMI decreased from 1 493 145 in 2005 to 581 924 in 2015. Estimated yearly incidence of ED visits for STEMI decreased from 1 402 768 to 315 813. The proportion of STEMI sent for immediate, same‐hospital catheterization increased from 12% to 37%. Among patients with STEMI sent directly for catheterization, median ED length of stay decreased from 62 to 37 minutes. ED administration of antithrombotic and nonaspirin antiplatelet agents rose for STEMI (23%–31% and 10%–27%, respectively). Conclusions National, real‐world trends in the epidemiology of AMI in the ED parallel those of clinical registries, with decreases in AMI incidence and STEMI proportion. ED care processes for STEMI mirror evolving guidelines that favor high‐intensity antiplatelet therapy, early invasive strategies, and regionalization of care.

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