Abstract 16488: Rural-urban Disparities in Hospital Care and Mortality Among Older Adults With Acute Myocardial Infarction, Heart Failure, and Ischemic Stroke in the United States

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Emefah C Loccoh ◽  
Karen E Joynt Maddox ◽  
Yun Wang ◽  
Dhruv Kazi ◽  
Robert W Yeh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Older Adults ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Mortality Rates ◽  
Rural Hospitals ◽  
Systemic Thrombolysis ◽  
Urban Hospitals ◽  
Rural And Urban

Introduction: Over the last decade, disparities in cardiovascular mortality have widened between rural and urban areas of the US. Our objective was to determine whether there were differences in treatment patterns and outcomes for acute cardiovascular conditions at rural and urban hospitals. Methods: We used 100% Medicare Claims to identify beneficiaries age 65 years hospitalized 1/1/2016-12/31/2017 for acute myocardial infarction (AMI), heart failure (HF), and ischemic stroke. We fit a mixed effects model with a logit link function and hospital random intercepts to evaluate condition-specific procedure rates (PCI/CABG, cerebral arteriography, systemic thrombolysis) and 30-day and 1-year mortality rates for beneficiaries admitted to rural vs. urban hospitals, adjusted for age, sex, dual enrollment, and clinical comorbidities. Results: Our study included 398,673 beneficiaries hospitalized for AMI (mean age 77.3 years), 690,218 for heart failure (80.3 years), and 378,170 for stroke (79.4 years). The proportion of AMI, HF, and stroke hospitalizations that occurred at rural hospitals was 10.7%, 14.2%, and 10.6%. Procedures were performed less frequently for beneficiaries admitted to rural compared with urban hospitals (PCI/CABG within 30 days of AMI: adjusted odds ratio [aOR] 0.50, 95% CI 0.47-0.54; cerebral arteriography [aOR 0.15, 0.11-0.22]; and systemic thrombolysis [aOR 0.47, 0.43-0.52] for stroke). Thirty-day mortality was higher at rural vs. urban hospitals for AMI (aOR 1.26, 1.21-1.31), HF (aOR 1.14, 1.11-1.17) and stroke (aOR 1.11, 1.07-1.16), as was 1-year mortality (AMI: aOR 1.31, 1.26-1.35; HF: aOR 1.10, 1.08-1.12; Stroke: aOR 1.14, 1.10-1.17). Conclusion: Older adults admitted to rural hospitals for acute cardiovascular conditions receive lower intensity care and experience higher mortality rates than those admitted to urban hospitals. Policy initiatives that improve cardiovascular care at rural hospitals are urgently needed.

scholarly journals Prediction of Hospital Acute Myocardial Infarction and Heart Failure 30-Day Mortality Rates Using Publicly Reported Performance Measures

2013 ◽  
Vol 35 (2) ◽  
pp. 15-23 ◽  
Author(s):  
David S. Aaronson ◽  
Naomi S. Bardach ◽  
Grace A. Lin ◽  
Arpita Chattopadhyay ◽  
Elizabeth L. Goldman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Performance Measures ◽  
Mortality Rates

scholarly journals Relationship Between Hospital Readmission and Mortality Rates for Patients Hospitalized With Acute Myocardial Infarction, Heart Failure, or Pneumonia

JAMA ◽  
2013 ◽  
Vol 309 (6) ◽  
pp. 587 ◽  
Author(s):  
Harlan M. Krumholz ◽  
Zhenqiu Lin ◽  
Patricia S. Keenan ◽  
Jersey Chen ◽  
Joseph S. Ross ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Hospital Readmission ◽  
Mortality Rates ◽  
Infarction Heart

scholarly journals The impact of diabetes and osteoarthritis on the occurrence of stroke, acute myocardial infarction, and heart failure among older adults with non-valvular atrial fibrillation in Hawaii: a retrospective observational cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masako Matsunaga ◽  
John J. Chen ◽  
Mayumi Jijiwa ◽  
Eunjung Lim
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Older Adults ◽  
Acute Myocardial Infarction ◽  
Cardiovascular Diseases ◽  
Observational Cohort Study ◽  
Observational Cohort ◽  
Disease Risks ◽  
Retrospective Observational Cohort Study

Abstract Background To date, little is known about cardiovascular disease risks among older adults with non-valvular atrial fibrillation by their association with diabetes and osteoarthritis status, based on longitudinal data with substantial amounts of non-white individuals. The objective of this study was to examine the risks for three cardiovascular diseases: stroke, acute myocardial infarction (AMI), and heart failure (HF), by diabetes and osteoarthritis status among older adults with non-valvular atrial fibrillation in Hawaii. Methods We conducted a retrospective observational cohort study for older adults (65 years and older) with non-valvular atrial fibrillation using the Hawaii Medicare data 2009–2017. Their risks for the three cardiovascular diseases by diabetes and osteoarthritis status (diabetes, osteoarthritis, diabetes and osteoarthritis, and without diabetes and osteoarthritis) were examined by multivariable Cox proportional hazard regression models. Results The analysis included 19,588 beneficiaries followed up for a maximum of 3288 days (diabetes: n = 4659, osteoarthritis: n = 1978, diabetes and osteoarthritis: n = 1230, without diabetes and osteoarthritis: n = 11,721).  Among them, those diagnosed with the cardiovascular diseases were identified (stroke: diabetes n = 837, osteoarthritis n = 315, diabetes and osteoarthritis n = 184, without diabetes and osteoarthritis n = 1630)(AMI: diabetes n = 438, osteoarthritis n = 128, diabetes and osteoarthritis n = 118, without diabetes and osteoarthritis n = 603)(HF: diabetes n = 2254, osteoarthritis n = 764, diabetes and osteoarthritis n = 581, without diabetes and osteoarthritis n = 4272). After adjusting for age, sex, race/ethnicity, and other potential confounders, those with diabetes and osteoarthritis had higher risks for HF (hazard ratio: 1.21 95% confidence interval: 1.10–1.33) than those without diabetes and osteoarthritis. They also had higher risks than those with osteoarthritis for HF. Those with diabetes had higher risks for all three cardiovascular diseases than the other three groups. Conclusions Variation in cardiovascular disease risks for older adults with non-valvular atrial fibrillation in Hawaii exists with diabetes and osteoarthritis status.

Abstract 14: Regional Cardiologist Density and 30-Day and 1-Year Mortality in Acute Myocardial Infarction and Heart Failure

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Vivek T Kulkarni ◽  
Joseph S Ross ◽  
Yongfei Wang ◽  
Brahmajee K Nallamothu ◽  
John A Spertus ◽  
...  
Keyword(s):  
United States ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
The United States ◽  
Mortality Rates ◽  
Lower Mortality ◽  
Administrative Claims ◽  
Physician Density ◽  
Hospital Referral

Background: Although the distribution of cardiologists and mortality for cardiovascular conditions are both known to vary across regions of the United States, no study has examined the relationship between regional cardiologist density and patient mortality for acute myocardial infarction (AMI) or heart failure (HF). Methods: We used 2010 Medicare administrative claims data for AMI and HF. Pneumonia (PN) was used as a control condition. Primary outcomes were death at 30 days and 1 year from admission. For each Hospital Referral Region (HRR), we used the 2010 Bureau of Health Professionals’ Area Resource File to define cardiologist density (number of cardiologists divided by population aged 65+) and 4 HRR characteristics: primary care physician density, total physician density, unemployment rate, and percent white race. We used 2-level hierarchical logistic regression models to examine the association between cardiologist density by tertile and mortality for each condition adjusting for (Model A) patient age, sex, and condition-specific comorbidities, and (Model B) patient and HRR characteristics. Results: Median (interquartile range) cardiologist density per 100,000 in the low, middle, and high tertiles of HRRs was 26.3 (22.9-29.9), 38.6 (36.5-43.1), and 64.5 (54.4-85.3), respectively. There were 171,126 admissions for AMI, 352,853 for HF, and 343,053 for PN. The 30-day mortality rates were 15.3% (26,290), 11.7% (41,121), and 11.9% (40,906), and 1-year mortality rates were 32.1% (55,292), 40.4% (142,612), and 35.2% (120,666), respectively (Table). For 30-day mortality, while model A showed lower mortality with higher cardiologist density for all conditions (odds ratios (ORs): 0.84-0.95), model B showed no associations. For 1-year mortality, while model A showed lower mortality in the high cardiologist density tertile for AMI (OR=0.93) and HF (OR=0.91) and no associations for PN, model B showed no associations for AMI or HF and higher mortality with higher cardiologist density for PN (ORs=1.04-1.06). Conclusion: After adjusting for patient and HRR characteristics, regional cardiologist density was not associated with 30-day or 1-year mortality for AMI or HF, suggesting that the uneven regional distribution of cardiologists across the United States does not affect patient outcomes.

Abstract 136: The Relationship of Changing Hospital Readmission Rates and Mortality Rates After Hospitalization for Heart Failure, Acute Myocardial Infarction, and Pneumonia

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Kumar Dharmarajan ◽  
Yongfei Wang ◽  
Susannah Bernheim ◽  
Zhenqiu Lin ◽  
Leora Horwitz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Hospital Readmission ◽  
Mortality Rates ◽  
Hospital Length Of Stay ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Monthly Changes ◽  
Monthly Change

Background: It is unknown if financial pressures to reduce hospital readmission rates following passage of the Affordable Care Act (ACA) have had the unintended effect of increasing mortality rates after hospitalization. We therefore examined correlations between paired changes in hospital 30-day readmission rates and 30-day mortality rates among Medicare fee-for-service beneficiaries hospitalized with heart failure (HF), acute myocardial infarction (AMI), or pneumonia from 2008 to 2014. Methods: We used linear regression to calculate monthly changes in hospitals’ 30-day risk-adjusted readmission rates (RARRs) and 30-day risk-adjusted mortality rates (RAMRs) after discharge for HF, AMI, and pneumonia from 2008 to 2014. Adjustment was made for patient age, sex, comorbidities, hospital length of stay, and season. We then examined the correlation of hospitals’ paired monthly changes in 30-day RARRs and monthly changes in 30-day RAMRs after discharge. Results: From 2008 to 2014, we identified 2,962,554, 1,229,939, and 2,544,530 hospitalizations for HF, AMI, and pneumonia at 5,016, 4,772, and 5,057 hospitals, respectively. Hospital 30-day RARRs declined for all three conditions from 2008 to 2014; the monthly change in RARRs was -0.053 (95% CI -0.055, -0.051) for HF, -0.044 (95% CI -0.047, -0.041) for AMI, and -0.033 (95% CI -0.035, -0.031) for pneumonia. In contrast, the monthly change in hospital 30-day RAMRs after discharge varied by admitting condition and was 0.008 (95% CI 0.007, 0.010) for HF, -0.003 (95% CI -0.006, -0.001) for AMI, and 0.001 (95% CI -0.001, 0.003) for pneumonia. The correlation between monthly changes in hospitals’ 30-day RARRs and 30-day RAMRs after discharge was 0.060 for HF (p<0.001), 0.059 for AMI (p=0.003), and 0.106 for pneumonia (p<0.001). Representative data showing the poor correlation in hospitals’ paired monthly changes in 30-day RARRs and 30-day RAMRs for AMI is shown in the Figure. Conclusion: Changes in hospital readmission rates for HF, AMI, and pneumonia were poorly correlated with changes in mortality rates after hospitalization between 2008 and 2014. These findings suggest that financial incentives to improve hospitals’ readmission performance have not increased mortality after hospitalization.

Long-term impact of the burden of new-onset atrial fibrillation in patients with acute myocardial infarction: data from the NOAFCAMI-SH registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.L Xu ◽  
J Luo ◽  
H.Q Li ◽  
Z.Q Li ◽  
B.X Liu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Cardiovascular Death ◽  
Funding Source ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background The prognostic implication of the burden of paroxysmal new-onset atrial fibrillation (NOAF) in patients with acute myocardial infarction (AMI) remains unclear. We aimed to determine the impact of NOAF burden on long-term cardiovascular outcomes in the setting of AMI. Methods This retrospective study was conducted to investigate the association of NOAF burden with the major adverse cardiac events (MACE, a composite of cardiovascular death, recurrent MI, worsening of heart failure, or ischemic stroke), using data from the New Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in ShangHai registry. AF burden was defined as the percentage of time (%) spent in AF. Patients with paroxysmal NOAF were divided into three groups according to AF burden tertiles: low burden: 22.4%. A restricted cubic spline analysis was performed to illusrate the relationship between the burden of NOAF and MACE. Results Of 2399 participants, 278 developed NOAF during a median monitoring period of 194.9 hours. The mean age was 65.8±12.4 years, and the median burden of NOAF was 8.4% (IQR: 1.9%-38.1%). During up to 5-years follow-up, the incidence of MACE was 8.6, 17.4, 35.4, and 79.2 per 100 person-years in the sinus rhythm, low-, intermediate-, and high-burden groups, respectively. After adjustment, patients with high NOAF burden had the highest risk of MACE (hazard ratio [HR]: 3.10; 95% confidence interval [CI]: 2.36–4.07), cardiovascular death (HR: 2.26; 95% CI: 1.58–2.23), worsening of heart failure (HR: 4.90; 95% CI: 3.48–4.91), and ischemic stroke (HR: 4.42; 95% CI: 2.03–9.63). Our splines analyses uncovered a nonlinear dose-response pattern, as the HRs of MACEs increased with the progression of NOAF burden and appeared stable after approximately 15% of NOAF burden. Conclusions A greater burden of NOAF during AMI was strongly associated with a higher risk of adverse cardiovascular events. Cumulative incidence of outcomes Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. National Natural Science Foundation of China, 2. Natural Science Foundation of Shanghai

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