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.

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 The Correlation of Infectious and Inherent Agents with Acute Myocardial Infarction in Patients of Teaching Hospitals in Qazvin in 2013

OALib ◽  
2015 ◽  
Vol 02 (08) ◽  
pp. 1-11
Author(s):  
Narges Dehghan Nejad ◽  
Leila Mostafaei ◽  
Farzaneh Jahanbakhshi ◽  
Fatemeh Rashvand ◽  
Mahmoud Heidari Alipour ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Teaching Hospitals

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

Effect of Hospital Characteristics on Performance of Pediatric Digit Replantation in the United States

2020 ◽  
Author(s):  
Neill Y. Li ◽  
Justin E. Kleiner ◽  
Edward J. Testa ◽  
Nicholas J. Lemme ◽  
Avi D. Goodman ◽  
...  
Keyword(s):  
United States ◽  
Pediatric Population ◽  
The United States ◽  
Teaching Hospitals ◽  
Level Of Evidence ◽  
Teaching Status ◽  
Private And Public ◽  
Subsequent Revision ◽  
Privately Owned ◽  
Hospital Characteristics

Abstract Introduction Utilize a national pediatric database to assess whether hospital characteristics such as location, teaching status, ownership, or size impact the performance of pediatric digit replantation following traumatic digit amputation in the United States. Materials and Methods The Kid’s Inpatient Database (KID) was used to query pediatric traumatic digit amputations between 2000 and 2012. Ownership (private and public), teaching status (teaching and non-teaching), location (urban and rural), hospital type (general and children’s), and size (large and small-medium) characteristics were evaluated. Replantations were then divided into those that required subsequent revision replantation or amputation. Fisher’s exact tests and multivariable logistic regressions were performed with p <0.05 considered statistically significant. Results Overall, 1,015 pediatric patients were included for the digit replantation cohort. Hospitals that were privately owned, general, large, urban, or teaching had a significantly greater number of replantations than small-medium, rural, non-teaching, public, or children’s hospitals. Privately owned (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.06–3.06; p = 0.03) and urban (OR: 2.29; 95% CI: 1.41–3.73; p = 0.005) hospitals were significantly more likely to perform replantation. Urban (OR: 4.02; 95% CI: 1.90–8.47; p = 0.0003) and teaching (OR: 2.11; 95% CI: 1.17–3.83; p = 0.014) hospitals were significantly more likely to perform a revision procedure following primary replantation. Conclusion Private and urban hospitals were significantly more likely to perform replantation, but urban and teaching hospitals carried a greater number of revision procedures following replantation. Despite risk of requiring revision, the treatment of pediatric digit amputations in private, urban, and teaching centers provide the greatest likelihood for an attempt at replantation in the pediatric population. The study shows Level of Evidence III.

Acute Myocardial Infarction Treatments in 58 Italian Hospitals: A Drug Utilization Survey

1995 ◽  
Vol 29 (11) ◽  
pp. 1100-1105 ◽  
Author(s):  
Francesca Venturini ◽  
Marilena Romero ◽  
Gianni Tognoni
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Thrombolytic Therapy ◽  
Drug Utilization ◽  
Beta Blockers ◽  
Heparin Therapy ◽  
Quality Data ◽  
Teaching Hospitals ◽  
Hospital Pharmacists ◽  
Therapeutic Practice

Objectives: To provide an updated and comprehensive profile of therapeutic practice in the management of acute myocardial infarction (AMI) in a sample of Italian hospitals, and to test the possible role of a network of hospital pharmacists in providing drug utilization data. Design: Prospective drug utilization survey. Participating pharmacists collected information on patients consecutively admitted to the hospital with a suspected AMI. The form reproduced those adopted in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico trials. Setting: Fifty-eight general hospitals in Italy belonging to the National Health Service, 6 of which are teaching hospitals. Thirty-four hospitals recruited patients from a coronary care unit, 10 from intensive monitoring beds in cardiology wards, and 14 from an intensive care unit. Participants: The study population consisted of patients consecutively admitted with a suspected AMI from May 31 through July 5, 1993. Main Outcome Measures: The management of AMI in terms of the use of drugs and nonpharmacologic treatments is described. Results: Of the 676 patients recruited for the study, 47.8% received thrombolytic therapy; alteplase was the preferred agent (55.4% of treated patients). The use of thrombolytic therapy varied significantly according to different demographic and clinical parameters such as age, sex, delay from the onset of symptoms to admission, and Killip scale class. During the first day of hospitalization 63.9% of patients received aspirin, 83.3% received nitrates, 24.8% received beta-blockers, and 77.1% received heparin therapy. Conclusions: Thrombolytic therapy was prescribed in a higher percentage of patients than is reported in the US, but lower than that reported in large trials. That a low percentage of patients who experienced a long delay between the onset of symptoms and admission as well as elderly patients received thrombolytic therapy reflects the lower expectations of clinicians for these subgroups of patients. A low proportion of patients received aspirin therapy. This study showed that in Italy an institutional network of hospital pharmacists could be interested observers of therapeutic practice, but further training is needed before high-quality data can be collected.

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

scholarly journals Hospital variation in admission to intensive care units for patients with acute myocardial infarction

2015 ◽  
Vol 170 (6) ◽  
pp. 1161-1169 ◽  
Author(s):  
RuiJun Chen ◽  
Kelly M. Strait ◽  
Kumar Dharmarajan ◽  
Shu-Xia Li ◽  
Isuru Ranasinghe ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Hospital Variation

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

Temporal trends and hospital variation in the management of severe hyperglycemia among patients with acute myocardial infarction in the United States

2013 ◽  
Vol 166 (2) ◽  
pp. 315-324.e1 ◽  
Author(s):  
Lakshmi Venkitachalam ◽  
Darren K. McGuire ◽  
Kensey Gosch ◽  
Kasia Lipska ◽  
Silvio E. Inzucchi ◽  
...  
Keyword(s):  
United States ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Temporal Trends ◽  
The United States ◽  
Hospital Variation
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