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

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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Patient sex and quality of emergency department care for patients with acute myocardial infarction

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2004.07.426 ◽

2004 ◽

Vol 44 (4) ◽

pp. S133-S134

Author(s):

D.R. Vinson ◽

D.J. Magid ◽

T.G. Padgett ◽

T.M. Vlugt ◽

A.S. Go ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Department ◽

Emergency Department Care

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National Study on the Quality of Emergency Department Care in the Treatment of Acute Myocardial Infarction and Pneumonia

Academic Emergency Medicine ◽

10.1197/j.aem.2007.06.035 ◽

2007 ◽

Vol 14 (10) ◽

pp. 856-863 ◽

Cited By ~ 6

Author(s):

Julius Cuong Pham ◽

Gabor D. Kelen ◽

Peter J. Pronovost

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Department ◽

National Study ◽

Emergency Department Care

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Abstract 14759: Burden of Intracranial Hemorrhage in Patients With Acute Myocardial Infarction in the United States, 2000-2017

Circulation ◽

10.1161/circ.142.suppl_3.14759 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Sri Harsha Patlolla ◽

Saraschandra Vallabhajosyula

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Length Of Stay ◽

Hospital Mortality ◽

Intracranial Hemorrhage ◽

Temporal Trends ◽

The United States ◽

Circulatory Support ◽

White Race ◽

Hospitalization Costs

Introduction: There is a paucity of contemporary data on the burden of intracranial hemorrhage (ICH) complicating acute myocardial infarction (AMI). Methods: The National Inpatient Sample database (2000 to 2017) was used to evaluate in-hospital burden of ICH in adult (>18 years) AMI admissions. In-hospital mortality, hospitalization costs, length of stay, and measure of functional ability were the outcomes of interest. The discharge destination along with use of tracheostomy and percutaneous endoscopic gastrostomy (PEG) were used to estimate functional burden. Results: Of a total 11,622,528 AMI admissions, 23,422 (0.2%) had concomitant ICH. Compared to those without, admissions with ICH were on average older, female, of non-White race, with greater comorbidities, and higher rates of arrhythmias (all p<0.001). Female sex, non-White race, ST-segment-elevation AMI presentation, use of fibrinolytics, mechanical circulatory support and invasive mechanical ventilation were identified as individual predictors of ICH. The AMI admissions with ICH received less frequent coronary angiography (46.9% vs. 63.8%), percutaneous coronary intervention (22.7% vs. 41.8%), and coronary artery bypass grafting (5.4% vs. 9.2%) as compared to those without (all p<0.001). ICH was associated with a significantly higher in-hospital mortality (41.4% vs. 6.1%; adjusted OR 5.65 [95% CI 5.47-5.84]; p<0.001), and adjusted temporal trends showed a steady decrease in in-hospital mortality over the 18-year period (Figure 1A). AMI-ICH admissions also had longer hospital length of stay, higher hospitalization costs, and greater use of PEG (all p<0.001). In AMI-ICH survivors (N=13, 689), 81.3% had a poor functional outcome indicating severe morbidity and temporal trends revealed a slight increase over the study period (Figure 1B). Conclusions: ICH causes a substantial burden in AMI due to associated higher in-hospital mortality, resource utilization, and poor functional outcomes.

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Abstract 491: Racial Disparities in the Trends of Acute Myocardial Infarction Outcomes Among Medicaid Patients, 2007-2011

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.37.suppl_1.491 ◽

2017 ◽

Vol 37 (suppl_1) ◽

Author(s):

Oluwole M Adegbala ◽

Akintunde Akinjero ◽

Samson Alliu ◽

Adeyinka C Adejumo ◽

Emmanuel Akintoye ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

African Americans ◽

Length Of Stay ◽

Hospital Mortality ◽

Racial Disparities ◽

Racial Differences ◽

Length Of Hospital Stay ◽

The United States ◽

Racial Groups

Background: Although, in-hospital mortality from acute myocardial infarction (AMI) have declined in the United States recently, there is a gap in knowledge regarding racial differences in this trend. We sought to evaluate the effect of race on the trends in outcomes after Acute Myocardial Infarction among Medicaid patients in a nationwide cohort from 2007-2011 Methods: We extracted data from the Nationwide Inpatient Sample (NIS) for all hospitalizations between 2007 and 2011 for Medicaid patients aged 45 years or older with principal diagnosis of AMI using ICD-9-CM codes. Primary outcome of this study was all cause in-hospital mortality. We then stratified hospitalizations by racial groups; Whites, African Americans and Hispanics, and assessed the time trends of in-hospital mortality before and after multivariate analysis. Results: The overall mortality from AMI among Medicaid patients declined during the study period (8.80% in 2007 to 7.46% in 2011). In the adjusted models, compared to 2007, in-hospital mortality from AMI for Medicaid patients decreased across the 3 racial groups; Whites (aOR= 0.88, CI=0.70-0.99), African Americans (aOR=0.76, CI=0.57-1.01), Hispanics (aOR=0.87, CI=0.66-1.25). While the length of hospital stay declined significantly among African American and Hispanic with 2 days and 1.76 days decline respectively, the length of stay remained unchanged for Whites. There was non-significant increase in the incidence of stroke across the various racial groups; Whites (aOR= 1.23, CI=0.90 -1.69), African Americans (aOR=1.10, CI=0.73 -1.64), Hispanics (aOR=1.03, CI=0.68-1.55) when compared to 2007. Conclusion: In this study, we found that in-hospital mortality from AMI among Medicaid patients have declined across the racial groups. However, while the length of stay following AMI declined for African Americans and Hispanics with Medicaid insurance, it has remained unchanged for Whites. Future studies are necessary to identify determinants of these significant racial disparities in outcomes for AMI.

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Update on quality of care in Hispanics and other racial-ethnic groups in the United States discharged with the diagnosis of Acute Myocardial Infarction in 2013

International Journal of Cardiology ◽

10.1016/j.ijcard.2017.07.004 ◽

2017 ◽

Vol 248 ◽

pp. 28-33 ◽

Cited By ~ 2

Author(s):

Tomás Romero ◽

Kristina L. Greenwood ◽

Dale Glaser

Keyword(s):

United States ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Quality Of Care ◽

Ethnic Groups ◽

The United States ◽

Racial Ethnic

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Older Emergency Department Patients With Acute Myocardial Infarction Receive Lower Quality of Care Than Younger Patients

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2004.12.012 ◽

2005 ◽

Vol 46 (1) ◽

pp. 14-21 ◽

Cited By ~ 38

Author(s):

David J. Magid ◽

Frederick A. Masoudi ◽

David R. Vinson ◽

Theresa M. van der Vlugt ◽

Thomas G. Padgett ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Department ◽

Quality Of Care ◽

Younger Patients ◽

Emergency Department Patients

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Investigating the geographic disparity in quality of care: the case of hospital readmission after acute myocardial infarction in Italy

The European Journal of Health Economics ◽

10.1007/s10198-020-01221-9 ◽

2020 ◽

Vol 21 (8) ◽

pp. 1149-1168

Author(s):

Yuxi Wang ◽

Simone Ghislandi ◽

Aleksandra Torbica

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Quality Of Care ◽

Length Of Stay ◽

Hospital Readmission ◽

Readmission Rate ◽

Healthcare Systems ◽

Unplanned Readmission ◽

Geographic Disparity

Abstract Unwarranted variation in the quality of care challenges the sustainability of healthcare systems. Especially in decentralised healthcare systems, it is crucial to understand the drivers behind regional differences in hospital qualities such as unplanned readmissions. This paper examines the factors that influence the risk of unplanned hospital readmission and the geographic disparity of readmission rate in Italy. We use hospital discharge data from 2010 to 2015 for patients above 65 years old admitted with Acute Myocardial Infarction. Employing hierarchical models, we identified the patient and hospital-level determinants for unplanned readmission. In line with the literature, the risk of readmission increases with age and being male, while hospitals with higher patient volume and capacity tend to have lower unplanned readmission. In particular, we find that after patient risk-adjustments, there are differential effects of hospitalisation length-of-stay on the probability of readmission across the hospitals that are governed by different payment systems. For hospitals under a prospective payment system, the effect of length-of-stay in reducing the probability of readmission is weaker than hospitals under an ex-post global budget, but the overall readmission rates are the lowest. Moreover, there are substantial geographic variations in readmission rate across Local Health Authority and regions, and these variations of unplanned readmission are explained by differences in hospital length-of-stay and surgical procedures used. Our results demonstrate that differential hospital behaviours can be one of the potential mechanisms that drive geographic quality disparities.

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Fragile X Syndrome-Associated Emergency Department Visits in the United States, 2006–2011

American Journal on Intellectual and Developmental Disabilities ◽

10.1352/1944-7558-125.2.103 ◽

2020 ◽

Vol 125 (2) ◽

pp. 103-108

Author(s):

Thuy Quynh N. Do ◽

Catharine Riley ◽

Pangaja Paramsothy ◽

Lijing Ouyang ◽

Julie Bolen ◽

...

Keyword(s):

Emergency Department ◽

Fragile X Syndrome ◽

Fragile X ◽

The United States ◽

Emergency Department Visits ◽

Surveillance Systems ◽

Diagnosis Code ◽

National Data ◽

Ed Visits

Abstract Using national data, we examined emergency department (ED) encounters during 2006–2011 for which a diagnosis code for fragile X syndrome (FXS) was present (n = 7,217). Almost half of ED visits coded for FXS resulted in hospitalization, which is much higher than for ED visits not coded for FXS. ED visits among females coded for FXS were slightly more likely to result in hospitalization. These findings underscore the importance of surveillance systems that could accurately identify individuals with FXS, track healthcare utilization and co-occurring conditions, and monitor quality of care in order to improve care and reduce FXS-associated morbidity.

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