Declining Trend in the In-Hospital Case-Fatality Rate From Acute Myocardial Infarction in Miyagi Prefecture From 1980 to 1999

When the population risk factors and reporting systems are similar, the assessment of the case-fatality (or lethality) rate (ratio of cases to deaths) represents a perfect tool for analyzing, understanding and improving the overall efficiency of the health system. The objective of this article is to estimate the influence of the hospital care system on lethality in metropolitan France during the inception of the COVID-19 epidemic, by analyzing the spatial variability of the hospital case-fatality rate between French districts (i.e. French departements). The results show that the higher case-fatality rates observed by districts are mostly related to the level of morbidity, therefore to the overwhelming of the healthcare systems during the acute phases of the epidemic. However, the magnitude of this increase of case-fatality rate represents less than 10 per cent of the average case-fatality rate and cannot explain the magnitude of the variations in case-fatality rate reported per country by international organizations or information sites. These differences can only be explained by the systems for reporting cases and deaths, which, indeed, vary greatly from country to country, and not attributed to the care or treatment of patients, even during hospital stress due to epidemic peaks.

Download Full-text

Impact of Vena Cava Filters on In-hospital Case Fatality Rate from Pulmonary Embolism

The American Journal of Medicine ◽

10.1016/j.amjmed.2011.05.025 ◽

2012 ◽

Vol 125 (5) ◽

pp. 478-484 ◽

Cited By ~ 119

Author(s):

Paul D. Stein ◽

Fadi Matta ◽

Daniel C. Keyes ◽

Gary L. Willyerd

Keyword(s):

Pulmonary Embolism ◽

Case Fatality Rate ◽

Vena Cava ◽

Case Fatality ◽

Fatality Rate ◽

Hospital Case ◽

Vena Cava Filters

Download Full-text

Abstract 13615: Weekdays versus Weekends: Outcomes of Cardiogenic Shock in the Setting of Acute Myocardial Infarction

Circulation ◽

10.1161/circ.142.suppl_3.13615 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Abel E Moreyra ◽

Deep Vakil ◽

Stavros Zinonos ◽

Nora M Cosgrove ◽

John B Kostis ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiogenic Shock ◽

Death Rate ◽

Case Fatality ◽

Continuous Variable ◽

Weekend Effect ◽

Circulatory Support ◽

Hospital Death ◽

Hospital Case

Introduction: Acute myocardial infarction (AMI) accounts for the majority of patients with cardiogenic shock (CS). The high case fatality justifies the need for an optimal hospital care system that is available 24 hours, 7 days a week. It is unclear whether the “weekend effect” has an impact on the outcome of CS associated with AMI. Hypothesis: Weekend CS-AMI admissions have a higher in-hospital case fatality than weekday admissions. Methods: A total of 22,632 patients with ST segment elevation AMI complicated with CS between the years 1986 to 2015 were identified in the Myocardial Infarction Data Acquisition System, a statewide database of all admissions to non-federal hospitals in NJ. Trend analysis was performed using a logistic regression model with admission year as a continuous variable. Case fatality rates between weekend vs weekday admissions were compared using the Cochran–Mantel–Haenszel test, stratifying by admission year. Results: From 1986 to 2015 there was a steady decline in the rates of in-hospital case fatality of AMI complicated with CS, from 79% to 33% (p< 0.001). The overall CS death rate for admissions on weekends was 61% and for weekdays 59% (Common-Odds Ratio = 1.10 (95% CI (1.02-1.17) p= 0.006) (figure). The use of mechanical circulatory support (MCS) was lower on weekends (p<0.001) and was associated with a higher case fatality rate 48 hours from admission (p<0.001). Conclusion: Deaths related to CS complicating AMI have steadily declined and this applies for both, patients admitted on weekends and weekdays. There was a higher hospital death rate in patients admitted over weekends compared to weekdays. The underutilization of MCS devices during weekends likely contributes to the difference in case fatality between weekends and weekdays.

Download Full-text

Incidence of shock complicating acute MI has remained constant, but the in-hospital case fatality rate has improved

Evidence-based Cardiovascular Medicine ◽

10.1054/ebcm.1999.0225 ◽

1999 ◽

Vol 3 (3) ◽

pp. 78

Author(s):

Judith S. Hochman ◽

Venu Menon

Keyword(s):

Case Fatality Rate ◽

Case Fatality ◽

Fatality Rate ◽

Hospital Case ◽

Acute Mi

Download Full-text

COVID-19: Spatial analysis of hospital case-fatality rate in France

PLoS ONE ◽

10.1371/journal.pone.0243606 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243606

Author(s):

Marc Souris ◽

Jean-Paul Gonzalez

Keyword(s):

Healthcare System ◽

Case Fatality Rate ◽

Healthcare Access ◽

Case Fatality ◽

Fatality Rate ◽

System Quality ◽

Hospital Data ◽

Average Case ◽

Hospital Case ◽

Age Related

When the population risk factors and reporting systems are similar, the assessment of the case-fatality (or lethality) rate (ratio of cases to deaths) represents a perfect tool for analyzing, understanding and improving the overall efficiency of the health system. The objective of this article is to estimate the influence of the hospital care system on lethality in metropolitan France during the inception of the COVID-19 epidemic, by analyzing the spatial variability of the hospital case-fatality rate (CFR) between French districts. In theory, the hospital age-standardized CFR should not display significant differences between districts, since hospital lethality depends on the virulence of the pathogen (the SARS-CoV-2 virus), the vulnerability of the population (mainly age-related), the healthcare system quality, and cases and deaths definition and the recording accuracy. We analyzed hospital data on COVID-19 hospitalizations, severity (admission to intensive care units for reanimation or endotracheal intubation) and mortality, from March 19 to May 8 corresponding to the first French lockdown. All rates were age-standardized to eliminate differences in districts age structure. The results show that the higher case-fatality rates observed by districts are mostly related to the level of morbidity. Time analysis shows that the case-fatality rate has decreased over time, globally and in almost all districts, showing an improvement in the management of severe patients during the epidemic. In conclusion, it appears that during the first critical phase of COVID-19 ramping epidemic in metropolitan France, the higher case-fatality rates were generally related to the higher level of hospitalization, then potentially related to the overload of healthcare system. Also, low hospitalization with high case-fatality rates were mostly found in districts with low population density, and could due to some limitation of the local healthcare access. However, the magnitude of this increase of case-fatality rate represents less than 10 per cent of the average case-fatality rate, and this variation is small compared to much greater variation across countries reported in the literature.

Download Full-text

Time trends and case fatality rate of in-hospital treated pulmonary embolism during 11 years of observation in Northwestern Italy

Thrombosis and Haemostasis ◽

10.1160/th15-02-0172 ◽

2016 ◽

Vol 115 (02) ◽

pp. 399-405 ◽

Cited By ~ 41

Author(s):

Walter Ageno ◽

Fulvio Pomero ◽

Luigi Fenoglio ◽

Alessandro Squizzato ◽

Matteo Bonzini ◽

...

Keyword(s):

Pulmonary Embolism ◽

Incidence Rate ◽

Time Trends ◽

Case Fatality Rate ◽

Case Fatality ◽

Population Based ◽

Fatality Rate ◽

Entire Study ◽

Mortality And Morbidity ◽

Hospital Case

SummaryPulmonary embolism (PE) is a common disorder with high mortality and morbidity rates. However, population-based information on its incidence and prognosis remains limited. We conducted a large epidemiology study collecting data on hospitalisation for PE (from 2002 to 2012) in a population of about 13 million people in Northwestern Italy. Patients were identified using the ICD-9-CM codes: 415.11, 415.19; gender and age specific incidence rate of PE during the study period were estimated using the resident population for each year of the study. Furthermore, time trends in the in-hospital PE-related mortality and case fatality rate were calculated. Results were adjusted for possible confounders. A total of 60,853 patients (mean age 72.8 years, ± 14.1, 59.6 % females) with PE were included; the overall crude incidence rate for the entire study period was 55.4 and 40.6 events per year per 100,000 inhabitants for women and men, respectively (p < 0.001). However, this difference was completely lost after standardisation for age. The incidence of PE significantly increased in both genders during the study period. In-hospital case fatality rate significantly decreased throughout the study period (p < 0.001) in women (from 15.6 % to 10.2 %) and in men (from 17.6 % to 10.1 %). The observed decrease of the in-hospital case-fatality throughout the study period remained significant also after adjustment for possible confounders. In conclusion, time trends over an 11-year period show an increasing incidence of PE, but a significant reduction in mortality during hospitalisation. Reduction in the case fatality rate remained significant after adjustment for these possible confounders.Supplementary Material to this article is available online at www.thrombosis-online.com.

Download Full-text