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Minhas AMK, Cullen MW, Mamas MA, Fudim M, Virani SS, Khan SS, Misra A, Ballantyne CM, Nambi V, Abramov D. Association Between Cardiologist Density and Mortality in Urban and Rural Counties in the United States. Am J Cardiol 2024; 210:279-282. [PMID: 37844717 DOI: 10.1016/j.amjcard.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Abdul Mannan Khan Minhas
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
| | - Michael W Cullen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Marat Fudim
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Department of Medicine, Duke Clinical Research Institute, Durham, North Carolina
| | - Salim S Virani
- Aga Khan University, Karachi, Pakistan; Baylor College of Medicine and Texas Heart Institute, Houston, Texas
| | - Sadiya S Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Arunima Misra
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Christie M Ballantyne
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
| | - Vijay Nambi
- Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
| | - Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Medical Center, Loma Linda, California.
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Minhas AMK, Parwani P, Fudim M, Virani SS, Khan SS, Cullen MW, Misra A, Ballantyne C, Nambi V, Abramov D. County-Level Cardiologist Density and Mortality in the United States. J Am Heart Assoc 2023; 12:e031686. [PMID: 38014694 PMCID: PMC10727342 DOI: 10.1161/jaha.123.031686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Affiliation(s)
| | - Purvi Parwani
- Division of Cardiology, Department of MedicineLoma Linda University Medical CenterLoma LindaCA
| | - Marat Fudim
- Department of MedicineDuke University Medical CenterDurhamNC
- Duke Clinical Research InstituteDurhamNC
| | - Salim S. Virani
- Aga Khan UniversityKarachiPakistan
- Baylor College of Medicine and Texas Heart InstituteHoustonTX
| | - Sadiya S. Khan
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | | | - Arunima Misra
- Department of MedicineBaylor College of MedicineHoustonTX
- Section of Cardiovascular ResearchBaylor College of MedicineHoustonTX
| | - Christie Ballantyne
- Department of MedicineBaylor College of MedicineHoustonTX
- Section of Cardiovascular ResearchBaylor College of MedicineHoustonTX
| | - Vijay Nambi
- Department of MedicineBaylor College of MedicineHoustonTX
- Section of Cardiovascular ResearchBaylor College of MedicineHoustonTX
| | - Dmitry Abramov
- Division of Cardiology, Department of MedicineLoma Linda University Medical CenterLoma LindaCA
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Chang J, Deng Q, Hu P, Guo M, Lu F, Su Y, Sun J, Qi Y, Long Y, Liu J. Geographic Variation in Mortality of Acute Myocardial Infarction and Association With Health Care Accessibility in Beijing, 2007 to 2018. J Am Heart Assoc 2023; 12:e029769. [PMID: 37301748 PMCID: PMC10356049 DOI: 10.1161/jaha.123.029769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/01/2023] [Indexed: 06/12/2023]
Abstract
Background Little is known about geographic variation in acute myocardial infarction (AMI) mortality within fast-developing megacities and whether changes in health care accessibility correspond to changes in AMI mortality at the small-area level. Methods and Results We included data of 94 106 AMI deaths during 2007 to 2018 from the Beijing Cardiovascular Disease Surveillance System in this ecological study. We estimated AMI mortality for 307 townships during consecutive 3-year periods with a Bayesian spatial model. Township-level health care accessibility was measured using an enhanced 2-step floating catchment area method. Linear regression models were used to examine the association between health care accessibility and AMI mortality. During 2007 to 2018, median AMI mortality in townships declined from 86.3 (95% CI, 34.2-173.8) to 49.4 (95% CI, 30.5-73.7) per 100 000 population. The decrease in AMI mortality was larger in townships where health care accessibility increased more rapidly. Geographic inequality, defined as the ratio of the 90th to 10th percentile of mortality in townships, increased from 3.4 to 3.8. In total, 86.3% (265/307) of townships had an increase in health care accessibility. Each 10% increase in health care accessibility was associated with a -0.71% (95% CI, -1.08% to -0.33%) change in AMI mortality. Conclusions Geographic disparities in AMI mortality among Beijing townships are large and increasing. A relative increase in township-level health care accessibility is associated with a relative decrease in AMI mortality. Targeted improvement of health care accessibility in areas with high AMI mortality may help reduce AMI burden and improve its geographic inequality in megacities.
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Affiliation(s)
- Jie Chang
- Center for Clinical and Epidemiologic ResearchBeijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Qiuju Deng
- Center for Clinical and Epidemiologic ResearchBeijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Piaopiao Hu
- Center for Clinical and Epidemiologic ResearchBeijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Moning Guo
- Beijing Municipal Health Big Data and Policy Research CenterBeijing Institute of Hospital ManagementBeijingChina
| | - Feng Lu
- Beijing Municipal Health Big Data and Policy Research CenterBeijing Institute of Hospital ManagementBeijingChina
| | - Yuwei Su
- School of Urban DesignWuhan UniversityWuhanChina
- School of Architecture and Hang Lung Center for Real Estate, Key Laboratory of Eco Planning & Green Building, Ministry of EducationTsinghua UniversityBeijingChina
| | - Jiayi Sun
- Center for Clinical and Epidemiologic ResearchBeijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Yue Qi
- Center for Clinical and Epidemiologic ResearchBeijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
| | - Ying Long
- School of Architecture and Hang Lung Center for Real Estate, Key Laboratory of Eco Planning & Green Building, Ministry of EducationTsinghua UniversityBeijingChina
| | - Jing Liu
- Center for Clinical and Epidemiologic ResearchBeijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing Municipal Key Laboratory of Clinical EpidemiologyBeijingChina
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Chang J, Deng Q, Hu P, Yang Z, Guo M, Lu F, Su Y, Sun J, Qi Y, Long Y, Liu J. Driving Time to the Nearest Percutaneous Coronary Intervention-Capable Hospital and the Risk of Case Fatality in Patients with Acute Myocardial Infarction in Beijing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3166. [PMID: 36833858 PMCID: PMC9961430 DOI: 10.3390/ijerph20043166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/24/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
Timely arrival at a hospital capable of percutaneous coronary intervention (PCI) is critical in treating acute myocardial infarction (AMI). We examined the association between driving time to the nearest PCI-capable hospital and case fatality among AMI patients. A total of 142,474 AMI events during 2013-2019 from the Beijing Cardiovascular Disease Surveillance System were included in this cross-sectional study. The driving time from the residential address to the nearest PCI-capable hospital was calculated. Logistic regression was used to estimate the risk of AMI death associated with driving time. In 2019, 54.5% of patients lived within a 15-min drive to a PCI-capable hospital, with a higher proportion in urban than peri-urban areas (71.2% vs. 31.8%, p < 0.001). Compared with patients who had driving times ≤15 min, the adjusted odds ratios (95% CI, p value) for AMI fatality risk associated with driving times 16-30, 31-45, and >45 min were 1.068 (95% CI 1.033-1.104, p < 0.001), 1.189 (95% CI 1.127-1.255, p < 0.001), and 1.436 (95% CI 1.334-1.544, p < 0.001), respectively. Despite the high accessibility to PCI-capable hospitals for AMI patients in Beijing, inequality between urban and peri-urban areas exists. A longer driving time is associated with an elevated AMI fatality risk. These findings may help guide the allocation of health resources.
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Affiliation(s)
- Jie Chang
- Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Qiuju Deng
- Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Piaopiao Hu
- Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Zhao Yang
- Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Moning Guo
- Beijing Municipal Health Big Data and Policy Research Center, Beijing Institute of Hospital Management, Beijing 100034, China
| | - Feng Lu
- Beijing Municipal Health Big Data and Policy Research Center, Beijing Institute of Hospital Management, Beijing 100034, China
| | - Yuwei Su
- School of Urban Design, Wuhan University, Wuhan 430072, China
- School of Architecture and Hang Lung Center for Real Estate, Key Laboratory of Eco Planning & Green Building, Ministry of Education, Tsinghua University, Beijing 100084, China
| | - Jiayi Sun
- Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Yue Qi
- Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
| | - Ying Long
- School of Architecture and Hang Lung Center for Real Estate, Key Laboratory of Eco Planning & Green Building, Ministry of Education, Tsinghua University, Beijing 100084, China
| | - Jing Liu
- Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100029, China
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Woods MJ, Lundgren SW, Poon CYM, Kupzyk KA, Alonso WW. Pre-left Ventricular Assist Device Cognition: A Comparison of Rural and Urban Implant Recipients. ASAIO J 2022; 68:369-373. [PMID: 35213885 DOI: 10.1097/mat.0000000000001491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mild cognitive impairment (MCI) is common in patients before left ventricular assist device (LVAD) placement. The consequences of these deficits may differentially impact groups of patients with limited access to postimplantation resources, such as those in rural areas. However, to date, no studies have examined preimplantation cognition in rural and urban patients. Therefore, the purpose of this study was to compare cognition in rural and urban patients before LVAD implantation. This observational cohort study is a secondary analysis of 265 patients undergoing LVAD implantation between July 2004 and June 2019. Preimplantation cognitive function was assessed. Rural-Urban Commuting Area Codes designated rural and urban. Independent-samples Mann-Whitney U tests were used to compare rural and urban cohorts. Subjects were 75.8% (201/265) male, 75.4% (200/265) urban, and 56.6% (±13.2) years old. Rural subjects scored significantly lower on the Mini Mental Status Exam (MMSE) (27 ± 2.20) and Wide Range Achievement Test (WRAT) (32 ± 22.9) compared with urban counterparts (MMSE, 27.6 ± 2.7) (p = 0.009); WRAT (44.4 ± 26.2) (p = 0.02) pre-LVAD. These findings suggest rural patients may have greater MCI before LVAD implantation. Rural LVAD recipients with MCI may require additional intensive education and tailored resource identification before discharge.
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Affiliation(s)
- Mallory J Woods
- From the College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska
| | - Scott W Lundgren
- Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Kevin A Kupzyk
- From the College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska
| | - Windy W Alonso
- From the College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska
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Differences in Hospitalization Outcomes of Kidney Disease between Patients Who Received Care by Nephrologists and Non-Nephrologist Physicians: A Propensity-Score-Matched Study. J Clin Med 2021; 10:jcm10225269. [PMID: 34830549 PMCID: PMC8623768 DOI: 10.3390/jcm10225269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/29/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022] Open
Abstract
The influence of physician specialty on the outcomes of kidney diseases (KDs) remains underexplored. We aimed to compare the complications and mortality of patients with admissions for KD who received care by nephrologists and non-nephrologist (NN) physicians. We used health insurance research data in Taiwan to conduct a propensity-score matched study that included 17,055 patients with admissions for KD who received care by nephrologists and 17,055 patients with admissions for KD who received care by NN physicians. Multivariable logistic regressions were conducted to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for 30-day mortality and major complications associated with physician specialty. Compared with NN physicians, care by nephrologists was associated with a reduced risk of 30-day mortality (OR 0.29, 95% CI 0.25–0.35), pneumonia (OR 0.82, 95% CI 0.76–0.89), acute myocardial infarction (OR 0.68, 95% CI 0.54–0.87), and intensive care unit stay (OR 0.78, 95% CI 0.73–0.84). The association between nephrologist care and reduced admission adverse events was significant in every age category, for both sexes and various subgroups. Patients with admissions for KD who received care by nephrologists had fewer adverse events than those who received care by NN physicians. We suggest that regular nephrologist consultations or referrals may improve medical care and clinical outcomes in this vulnerable population.
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Zhang Y, Li C, Pei Y, Zheng L, Sun X, Zhao Z, Wang S. Trelagliptin ameliorates oxygen-glucose deprivation/reperfusion (OGD/R)-induced mitochondrial dysfunction and metabolic disturbance of endothelial cells. Hum Cell 2021; 34:1717-1726. [PMID: 34435315 DOI: 10.1007/s13577-021-00594-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022]
Abstract
Acute myocardial infarction (AMI) is a severe cardiovascular disease with high mortality. It is reported to be closely related to the mitochondrial dysfunction and metabolic disturbance on endothelial cells under a chronic hypoxic state. Significant declined mitochondrial respiration, ATP production, and metabolic changes are the main characteristics of endothelial injury in the disease. Trelagliptin is a DPP-4 inhibitor applied for the treatment of type II diabetes and has been recently reported to exert various pharmacological properties. In this investigation, we examined whether Trelagliptin possessed a protective effect against mitochondrial dysfunction and metabolic disturbance in human aortic valvular endothelial cells (HAVECs) under oxygen-glucose deprivation/reperfusion (OGD/R) conditions. We found that both the cytotoxicity and mitochondrial oxidative stress in HAVECs induced by OGD/R stimulation were greatly alleviated by Trelagliptin. In addition, the declined mitochondrial respiration and ATP production decreased secretion of cystathionine and creatine, and the increased production of triglyceride and adiponectin in OGD/R-challenged HAVECs was dramatically reversed by Trelagliptin, accompanied by the upregulated expression level of PGC-1α and CPT-1. Lastly, the AMPK pathway was observed to be significantly activated in OGD/R-challenged HAVECs by Trelagliptin treatment. After co-administration of the inhibitor of the AMPK pathway, the effects of Trelagliptin on mitochondrial function and metabolic alterations were significantly abolished. Taken together, our data indicate that Trelagliptin ameliorated OGD/R-induced mitochondrial disturbance and metabolic changes by activating the AMPK pathway.
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Affiliation(s)
- Yatong Zhang
- Department of pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, 100730, China
| | - Chao Li
- Department of pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, 100730, China
| | - Yifang Pei
- Department of pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, 100730, China
| | - Li Zheng
- Department of Pharmacy, China Aerospace Science and Industry Corporation 731 Hospital, Beijing, 100074, China
| | - Xuelin Sun
- Department of pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, 100730, China
| | - Zinan Zhao
- Department of pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, 100730, China
| | - Shuanghu Wang
- The Laboratory of Clinical Pharmacy, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, #15 Dazhong Street, Liandu District, Lishui City, 323000, Zhejiang, China.
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Nishimura K, Ogasawara K, Kitazono T, Iihara K. Impact of Physician Volume and Specialty on In-Hospital Mortality of Ischemic and Hemorrhagic Stroke. Circ J 2021; 85:1876-1884. [PMID: 34393151 DOI: 10.1253/circj.cj-20-1214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The degree of association between mortality and case volume/physician volume is well known for many surgical procedures and medical conditions. However, the link between physician volume and death rate in patients hospitalized for stroke remains unclear. This study analyzed the correlation between in-hospital stroke mortality and physician volume per hospital, considering board certification status.Methods and Results:For this retrospective registry-based cohort study, data were obtained from the Japanese nationwide registry on patients hospitalized for ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) between 2010 and 2016. The number of stroke care physicians and relevant board-certified physicians was also obtained. Odd ratios (ORs) of 30-day in-hospital mortality were estimated after adjusting for institutional and patient differences using generalized mixed logistic regression. From 295,150 (ischemic stroke), 98,657 (ICH), and 36,174 (SAH) patients, 30-day in-hospital mortality rates were 4.4%, 16.0%, and 26.6%, respectively. There was a correlation between case volume and physician volume. A higher number of stroke care physicians was associated with a reduction in 30-day mortality after adjusting for stroke case volume and comorbidities for all stroke types (all P for trend<0.05). CONCLUSIONS An increased number of stroke care physicians was associated with reduced in-hospital mortality for all types of stroke. The volume threshold of board-certified physicians depends on the specialty and stroke type.
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Affiliation(s)
- Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center
| | | | - Takanari Kitazono
- Department of Medicine and Clinical Science, Kyushu University Graduate School of Medical Sciences
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Fu X, Wilson P, Chung WSF. Time-to-reperfusion in patients with acute myocardial infarction and mortality in prehospital emergency care: meta-analysis. BMC Emerg Med 2020; 20:65. [PMID: 32842962 PMCID: PMC7448494 DOI: 10.1186/s12873-020-00356-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND People living in rural areas usually suffer comparatively disadvantaged emergency health care than those living in urban areas, reasons including long transit time due to geographic factors. As for many time critical diseases, it is necessary to obtain treatment as quickly as possible. METHODS Screening of eligible studies were conducted based on inclusion an exclusion criteria. A comprehensive search was conducted by using following database: EMBASE, Medline, Cochrane library and Scopus. Quality assessment tool for observational cohort and cross-sectional study is used for assessing the risk of bias. The time group were defined based on the median or mean transit time among patients. In symptom onset-balloon time, we take 120 min transit time as the standard so patients in included studies are divided into two groups:less than 120 min (group A) and more than 120 min (group B). The collected data were used for quantitative analysis, they were inputted into Review Manager Software (v5.3) to produce summary results. RESULTS Ten studies representing 71,099 patients were included in the meta-analysis. All studies were retrospective and prospective observational studies and RCTs in which patients experienced ST-elevation myocardial infarction (STEMI) and were treated with percutaneous coronary intervention (PCI). Random effects meta-analysis of the point estimate was 0.69 (CI 0.60, 0.79). Heterogeneity between study results was evaluated via examination of the forest plots and quantified by using I2 statistic. Heterogeneity in two stage time was moderate among studies (I2 = 29%, P = 0.23). CONCLUSION The meta-analysis for included studies report less mortality in less than 120 min symptom onset-balloon and door-balloon time than that in more than 120 min. It is necessary to optimize the prehospital system for rapid decision making and logical destination and mode of transport with prehospital notification of the cath lab so that the hospital is ready to optimize door to balloon time.
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Affiliation(s)
- Xing Fu
- Chengdu Center for Disease Control and Prevention, Chengdu, China
| | - Philip Wilson
- University of Aberdeen, Aberdeen, The United Kingdom of Great Britain and Northern Ireland, Aberdeen, UK
| | - Wing Sun Faith Chung
- University of Aberdeen, Aberdeen, The United Kingdom of Great Britain and Northern Ireland, Aberdeen, UK
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Lu PW, McCarty JC, Fields AC, Azzeh M, Goldberg JE, Irani J, Bleday R, Melnitchouk N. The Distribution of Colorectal Surgeons in the United States. J Surg Res 2020; 251:71-77. [DOI: 10.1016/j.jss.2020.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/14/2020] [Accepted: 01/25/2020] [Indexed: 11/30/2022]
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Timmis A, Townsend N, Gale CP, Torbica A, Lettino M, Petersen SE, Mossialos EA, Maggioni AP, Kazakiewicz D, May HT, De Smedt D, Flather M, Zuhlke L, Beltrame JF, Huculeci R, Tavazzi L, Hindricks G, Bax J, Casadei B, Achenbach S, Wright L, Vardas P. European Society of Cardiology: Cardiovascular Disease Statistics 2019. Eur Heart J 2020; 41:12-85. [PMID: 31820000 DOI: 10.1093/eurheartj/ehz859] [Citation(s) in RCA: 607] [Impact Index Per Article: 151.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023] Open
Abstract
AIMS The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets. METHODS AND RESULTS In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index ≥30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.5-23.1%] vs. 15.7% (IQR 14.5-21.1%)}, diabetes [7.7% (IQR 7.1-10.1%) vs. 5.6% (IQR 4.8-7.0%)], and among males smoking [43.8% (IQR 37.4-48.0%) vs. 26.0% (IQR 20.9-31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0-10.8) vs. 16.7% (IQR 13.9-19.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 5655-8115)] compared with high-income [2235 (IQR 1896-3602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures. CONCLUSION A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest.
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Affiliation(s)
- Adam Timmis
- Barts Heart Centre and Queen Mary University London, London, UK
| | | | - Chris P Gale
- Medical Research Council Bioinformatics Centre, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | | | | | | | - Aldo P Maggioni
- Research Center of Italian Association of Hospital Cardiologists (ANMCO), Florence, Italy
| | - Dzianis Kazakiewicz
- European Society of Cardiology Health Policy Unit, European Heart Health Institute, European Heart Agency, Brussels, Belgium
| | - Heidi T May
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Marcus Flather
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Liesl Zuhlke
- Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - John F Beltrame
- University of Adelaide, Central Adelaide Local Health Network, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Radu Huculeci
- European Society of Cardiology Health Policy Unit, European Heart Health Institute, European Heart Agency, Brussels, Belgium
| | - Luigi Tavazzi
- Maria Cecilia Hospital-GVM Care&Research, Cotignola, Italy
| | | | - Jeroen Bax
- Leiden University Medical Center, Leiden, The Netherlands
| | - Barbara Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Level 6, West Wing, Oxford, UK
| | - Stephan Achenbach
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Lucy Wright
- Nuffield Department of Population Health, University of Oxford, Headington, Oxford, UK
| | - Panos Vardas
- European Society of Cardiology Health Policy Unit, European Heart Health Institute, European Heart Agency, Brussels, Belgium
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Yoneyama K, Kanaoka K, Okayama S, Nishimura K, Nakai M, Matsushita K, Miyamoto Y, Kida K, Ishibashi Y, Izumo M, Watanabe M, Soeda T, Okura H, Harada T, Yasuda S, Murohara T, Ogawa H, Saito Y, Akashi YJ. Association between the number of board-certified cardiologists and the risk of in-hospital mortality: a nationwide study involving the Japanese registry of all cardiac and vascular diseases. BMJ Open 2019; 9:e024657. [PMID: 31843816 PMCID: PMC6924792 DOI: 10.1136/bmjopen-2018-024657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Although there are 14 097 board-certified cardiologists in Japan, it is unknown whether the number of institutional board-certified cardiologists is related to the prognosis of cardiovascular disease patients. DESIGN Cross-sectional analysis. SETTING Data were collected from the nationwide database of acute care hospitals in Japan (2371 hospitals) between 2012 and 2013. PARTICIPANTS A total of 1 422 703 consecutive patients were initially included in this study, but 518 610 patients were excluded due to age <18 years, missing data or prior hospitalisations; therefore, 896 171 patients comprised the final sample population. MAIN OUTCOME MEASURES The primary outcome was in-hospital mortality due to any cause. For the per-hospital analysis, Poisson regression models were used to estimate the association of board-certified cardiologists with in-hospital mortality, adjusted for hospital facilitation. For the per-patient analysis, hierarchical logistic regression models were used to estimate the ORs of the number of institutional board-certified cardiologists, adjusted for patient demographics, diagnoses, therapies and hospital facilities. RESULTS The regression model of the per-hospital analysis indicated that the number of board-certified cardiologists was associated with a lower rate ratio of in-hospital mortality (rate ratio, 0.988; 95% CI 0.983 to 0.993; p<0.01). The per-patient analysis indicated that the median age was 73 years and the in-hospital mortality rate was 11.7%. The regression model indicated that the presence of more board-certified cardiologists was associated with a lower risk of in-hospital mortality (OR, 0.980; 95% CI 0.975 to 0.986; p<0.01) after adjustments for hospital facilities, patient characteristics and treatments. CONCLUSIONS Among cardiovascular disease patients admitted to acute care hospitals in Japan, the presence of more board-certified cardiologists was associated with a lower risk of in-hospital mortality. These results have implications for national and institutional strategies for determining the required number of board-certified cardiologists.
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Affiliation(s)
- Kihei Yoneyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Koshiro Kanaoka
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Satoshi Okayama
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Kunihiro Nishimura
- Preventive Medicine and Epidemiology Informatics, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Michikazu Nakai
- Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yoshihiro Miyamoto
- Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yuki Ishibashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Hiroyuki Okura
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoo Harada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine Faculty of Medicine, Nagoya, Aichi, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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Lattuca B, Kerneis M, Saib A, Nguyen LS, Payot L, Barthélemy O, Le Feuvre C, Helft G, Choussat R, Collet JP, Montalescot G, Silvain J. On- Versus Off-Hours Presentation and Mortality of ST-Segment Elevation Myocardial Infarction Patients Treated With Primary Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 12:2260-2268. [PMID: 31678083 DOI: 10.1016/j.jcin.2019.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/02/2019] [Accepted: 07/11/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The authors sought to assess the association between admission time with patient's care, procedure characteristics, and clinical outcomes within a contemporary ST-segment elevation myocardial infarction (STEMI) network of patients referred for primary percutaneous coronary intervention (PCI). BACKGROUND The effect of admission time on STEMI patient's outcomes remains controversial when primary PCI is the preferred reperfusion strategy. METHODS Characteristics and clinical outcomes of 2,167 consecutive STEMI patients admitted in a tertiary PCI-capable center were collected. On-hours were defined as admission from Monday through Friday between 8 am and 6 pm and off-hours as admission during night shift, weekend, and nonworking holidays. In-hospital and 1-year all-cause mortality were assessed as well as key time delays. RESULTS A total of 1,048 patients (48.3%) were admitted during on-hours, and 1,119 patients (51.7%) during off-hours. Characteristics were well-balanced between the 2 groups, including rates of cardiac arrest (7.9% vs. 8.8%; p = 0.55) and cardiogenic shock (12.3% vs. 14.7%; p = 0.16). Median symptom-to-first medical contact time and median first medical contact-to-sheath insertion time did not differ according to on- versus off-hours admission (120 min vs. 126 min; p = 0.25 and 90 min vs. 93 min; p = 0.58, respectively), as well as the rate of radial access for catheterization (85.6% vs. 87.5%; p = 0.27). There was no association between on- versus off-hours groups and in-hospital (8.1% vs. 7.0%; p = 0.49) or 1-year mortality (11.0% vs. 11.1%; p = 0.89), respectively. CONCLUSIONS In a contemporary organized STEMI network, patients admitted in a high-volume tertiary primary PCI center during on-hours or off-hours had similar management and 1-year outcomes.
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Affiliation(s)
- Benoit Lattuca
- Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Mathieu Kerneis
- Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Anis Saib
- Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Lee S Nguyen
- Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Laurent Payot
- Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Olivier Barthélemy
- Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Claude Le Feuvre
- Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Gérard Helft
- Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Remi Choussat
- Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Jean-Philippe Collet
- Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
| | - Gilles Montalescot
- Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Johanne Silvain
- Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
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- Sorbonne University, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
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15
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Patel TM, Shah SC, Pancholy SB. Long Distance Tele-Robotic-Assisted Percutaneous Coronary Intervention: A Report of First-in-Human Experience. EClinicalMedicine 2019; 14:53-58. [PMID: 31709402 PMCID: PMC6833466 DOI: 10.1016/j.eclinm.2019.07.017] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 07/05/2019] [Accepted: 07/30/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Robotic-assisted percutaneous coronary intervention (R-PCI) has been successfully employed in the United States since 2011. Performing R-PCI from a remote location has never been reported but if feasible would extend availability of treatment to many patients with coronary artery disease (CAD) who would otherwise go without. OBJECTIVE To assess the feasibility of remote tele-R-PCI with the operator 20 miles away from the patients. METHODS Five patients with single, type A coronary artery lesions treatable by PCI consented to participate. The primary endpoint was procedural success with no major adverse cardiac events (MACE) before discharge. Procedural success was defined as achieving < 10% diametric stenosis of the occluded target vessel utilizing tele-R-PCI balloon angioplasty and stent deployment (CorPath GRX®, Corindus Vascular Robotics, USA) without converting to in-lab manual PCI by an on-site standby team. Procedural, angiographic, and safety data were collected as were questionnaire scores from the remote operator evaluating the robot-network composite, image clarity, and overall confidence in the procedure. RESULTS The primary endpoint was achieved in 100% of patients. No procedural complications or adverse events occurred, and all patients were discharged the following day without MACE. The operator scores were favorable with the operators rating the procedure as equivalent to an in-lab procedure. CONCLUSIONS Performing long distance tele-R-PCI in patients with CAD is feasible with predictably successful outcomes if reliable network connectivity and local cardiac catheterization facilities are available.
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Affiliation(s)
- Tejas M. Patel
- Apex Heart Institute, Ahmedabad, India
- Corresponding author at: Apex Heart Institute, Ahmedabad, India.
| | | | - Samir B. Pancholy
- The Wright Center for Graduate Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
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16
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Geographic Distribution of Hand Surgeons Throughout the United States. J Hand Surg Am 2018; 43:668-674. [PMID: 29678426 DOI: 10.1016/j.jhsa.2018.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 03/06/2018] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to evaluate the geographic distribution of hand surgeons in the United States. We assessed the states and congressional districts (CDs) for optimal numbers of surgeons, determined whether there is an even distribution, and identified factors influencing practice location. Hand surgeon practice location data from the American Association for Hand Surgery and American Society for Surgery of the Hand (2015) and both state and CD population data from the US Census (2014) were assessed. CDs each contain approximately the same population. Furthermore, select hand surgeons were asked to fill out a survey to identify how 6 factors influence practice location. A total of 2,707 American Association for Hand Surgery active and American Society for Surgery of the Hand active and candidate US members were included. The mean number of hand surgeons per state was 53 (range: 3-298). The most hand surgeons were in California, Texas, New York, and Florida and least were in Wyoming and Alaska. There were 16, 11, and 24 states with suboptimal, optimal, and greater-than-optimal density, respectively. There were 436 CDs. We found 231, 30, and 175 CDs with suboptimal, optimal, and greater-than-optimal density, respectively. There were weak correlations between hand surgeons and CD populations and between CD population densities and CD hand surgeons per capita. Twenty hand surgeons were included in the survey resulting in no difference of any 1 factor compared with the other 5 factors. There was a difference in the factor "population size" between hand surgeons from greater-than-optimal and suboptimal CDs. The findings of our study indicate that hand surgeon proportions do not correlate with population proportions, and distribution is not skewed toward areas of higher population density. Many areas are not optimally served, and hand surgeons may be choosing where to practice based on a combination of factors beyond population need.
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Association between number of institutions with coronary computed tomography angiography and regional mortality ratio of acute myocardial infarction: a nationwide ecological study using a spatial Bayesian model. Int J Health Geogr 2018; 17:13. [PMID: 29784002 PMCID: PMC5963166 DOI: 10.1186/s12942-018-0133-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/15/2018] [Indexed: 02/08/2023] Open
Abstract
Background Coronary computed tomography angiography (CTA) has demonstrated high diagnostic accuracy for detection of coronary artery stenosis, and healthcare providers can detect coronary artery disease in earlier stages before it develops into more serious clinical conditions such as acute myocardial infarction (AMI). We hypothesized that the mortality ratio of AMI in regions with a higher density of coronary CTA is lower than that in regions with a lower density of coronary CTA. Methods This ecological and cross-sectional study using secondary data targeted all secondary medical service areas (SMSAs) in Japan (n = 349). We obtained the numbers of cardiologists, institutions with coronary CTA, and institutions with a cardiac catheterization laboratory (CCL) as medical resources, socioeconomic factors, lifestyle factors, exercise habit factors, and AMI mortality data from a Japanese national database. We evaluated the association between the number of these medical resources and the standardized mortality ratio (SMR) of AMI in each SMSA using a hierarchical Bayesian model accounting for spatial autocorrelation (i.e., a conditional autoregressive model). We assumed a Poisson distribution for the observed number of AMI-related deaths and set the expected number of AMI-related deaths as the offset variable. Results The number of institutions with coronary CTA was negatively and significantly associated with the SMR of AMI (relative risk [RR] 0.900; 95% credible interval [CI] 0.848–0.953), while the SMR in each SMSA was not significantly associated with the number of either cardiologists (RR 0.997; 95% CI 0.988–1.004) or institutions with a CCL (RR 1.026; 95% CI 0.963–1.096). Conclusions We observed a significant association between the number of institutions with coronary CTA and the SMR of AMI. Effective allocation of coronary CTA in each region is recommended, and it would be important to clarify the standing position of coronary CTA in regional networking for AMI treatment in the future. Electronic supplementary material The online version of this article (10.1186/s12942-018-0133-0) contains supplementary material, which is available to authorized users.
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18
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Ogita M, Suwa S, Ebina H, Nakao K, Ozaki Y, Kimura K, Ako J, Noguchi T, Yasuda S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Saito Y, Hirohata A, Morita Y, Inoue T, Okamura A, Uematsu M, Hirata K, Tanabe K, Shibata Y, Owa M, Hokimoto S, Funayama H, Kokubu N, Kozuma K, Uemura S, Toubaru T, Saku K, Oshima S, Nishimura K, Miyamoto Y, Ishihara M. Off-hours presentation does not affect in-hospital mortality of Japanese patients with acute myocardial infarction: J-MINUET substudy. J Cardiol 2017; 70:553-558. [PMID: 28684209 DOI: 10.1016/j.jjcc.2017.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/11/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The association between patients with acute myocardial infarction (AMI) who present during off-hours and clinical outcomes has not been fully elucidated. METHODS We investigated 3283 consecutive patients with AMI who were selected from a prospective, nationwide, multicenter registry (J-MINUET) database comprising 28 institutions in Japan between July 2012 and March 2014 to determine the current impact of off-hours presentation on in-hospital mortality among Japanese patients with AMI. RESULTS Among the patients, 52% presented in off-hours. Baseline characteristics were comparable, although those who presented during off-hours were younger and had a higher incidence of ST-elevation myocardial infarction and advanced Killip Class. The time from symptom onset to presentation time was shorter in off-hour patients (120min, interquartile range 60 to 256 vs. 215min, interquartile range 90 to 610, p<0.0001). In contrast, 85% of patients underwent primary percutaneous coronary intervention (PCI) and door to balloon time was comparable between the groups (74min, interquartile range 52 to 113 vs. 75min, interquartile range 52 to 126, p=0.34). The rates of in-hospital mortality were comparable (6.2% vs 6.8%, p=0.39). Multivariate logistic regression analysis revealed that off-hours presentation was not significantly associated with in-hospital mortality [odds ratio (OR) 0.94; 95% CI, 0.68-1.30, p=0.70]. CONCLUSION The clinical impact of presenting during off-hours or regular hours on AMI patients in Japan is comparable in contemporary practice. TRIAL REGISTRATION UMIN Unique trial Number: UMIN000010037.
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Affiliation(s)
- Manabu Ogita
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan.
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Hideki Ebina
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University, Sagamihara, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuteru Fujimoto
- Department of Cardiology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Yasuharu Nakama
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Takashi Morita
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Atsushi Hirohata
- Department of Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Atsunori Okamura
- Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Masaaki Uematsu
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Kazuhito Hirata
- Department of Cardiology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Mafumi Owa
- Department of Cardiovascular Medicine, Suwa Red Cross Hospital, Suwa, Japan
| | - Seiji Hokimoto
- Department of Cardiovascular Medicine, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan
| | - Hiroshi Funayama
- Department of Integrated Medicine, Saitama Medical Center Jichi Medical University, Saitama, Japan
| | - Nobuaki Kokubu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University, Tokyo, Japan
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Tetsuya Toubaru
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shigeru Oshima
- Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiro Miyamoto
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masaharu Ishihara
- Division of Coronary Artery Disease, Hyogo College of Medicine, Nishinomiya, Japan
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Narang A, Sinha SS, Rajagopalan B, Ijioma NN, Jayaram N, Kithcart AP, Tanguturi VK, Cullen MW. The Supply and Demand of the Cardiovascular Workforce: Striking the Right Balance. J Am Coll Cardiol 2016; 68:1680-1689. [PMID: 27712782 PMCID: PMC5351767 DOI: 10.1016/j.jacc.2016.06.070] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 06/20/2016] [Accepted: 06/28/2016] [Indexed: 12/27/2022]
Abstract
As the burden of cardiovascular disease in the United States continues to increase, uncertainty remains on how well-equipped the cardiovascular workforce is to meet the challenges that lie ahead. In a time when health care is rapidly shifting, numerous factors affect the supply and demand of the cardiovascular workforce. This Council Commentary critically examines several factors that influence the cardiovascular workforce. These include current workforce demographics and projections, evolving health care and practice environments, and the increasing burden of cardiovascular disease. Finally, we propose 3 strategies to optimize the workforce. These focus on cardiovascular disease prevention, the effective utilization of the cardiovascular care team, and alterations to the training pathway for cardiologists.
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Affiliation(s)
- Akhil Narang
- Section of Cardiology, University of Chicago, Chicago, Illinois.
| | - Shashank S Sinha
- Division of Cardiovascular Medicine, Samuel and Jean Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Bharath Rajagopalan
- Division of Cardiovascular Medicine, University at Buffalo, Buffalo, New York
| | | | - Natalie Jayaram
- Division of Cardiology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Aaron P Kithcart
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Varsha K Tanguturi
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael W Cullen
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Mizuno S, Kunisawa S, Sasaki N, Fushimi K, Imanaka Y. In-hospital mortality and treatment patterns in acute myocardial infarction patients admitted during national cardiology meeting dates. Int J Cardiol 2016; 220:929-36. [PMID: 27420345 DOI: 10.1016/j.ijcard.2016.06.168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many hospitals experience a reduction in the number of available physicians on days when national scientific meetings are conducted. This study investigates the relationship between in-hospital mortality in acute myocardial infarction (AMI) patients and admission during national cardiology meeting dates. METHODS Using an administrative database, we analyzed patients with AMI admitted to acute care hospitals in Japan from 2011 to 2013. There were 3 major national cardiology meetings held each year. A hierarchical logistic regression model was used to compare in-hospital mortality and treatment patterns between patients admitted on meeting dates and those admitted on identical days during the week before and after the meeting dates. RESULTS We identified 6,332 eligible patients, with 1,985 patients admitted during 26 meeting days and 4,347 patients admitted during 52 non-meeting days. No significant differences between meeting and non-meeting dates were observed for in-hospital mortality (7.4% vs. 8.5%, respectively; p=0.151, unadjusted odds ratio: 0.861, 95% confidence interval: 0.704-1.054) and the proportion of percutaneous coronary intervention (PCI) performed on the day of admission (75.9% vs. 76.2%, respectively; p=0.824). We also found that some low-staffed hospitals did not treat AMI patients during meeting dates. CONCLUSION Little or no "national meeting effect" was observed on in-hospital mortality in AMI patients, and PCI rates were similar for both meeting and non-meeting dates. Our findings also indicated that during meeting dates, AMI patients may have been consolidated to high-performance and sufficiently staffed hospitals.
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Affiliation(s)
- Seiko Mizuno
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yosihida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yosihida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Noriko Sasaki
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yosihida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yosihida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
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Spatz ES, Beckman AL, Wang Y, Desai NR, Krumholz HM. Geographic Variation in Trends and Disparities in Acute Myocardial Infarction Hospitalization and Mortality by Income Levels, 1999-2013. JAMA Cardiol 2016; 1:255-65. [PMID: 27438103 PMCID: PMC5459393 DOI: 10.1001/jamacardio.2016.0382] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE During the past decade, the incidence and mortality associated with acute myocardial infarction (AMI) in the United States have decreased substantially. However, it is unknown whether these improvements were consistent across communities of different economic status and geographic regions since efforts to improve cardiovascular disease prevention and management may have had variable impact. OBJECTIVE To determine whether trends in US county-level, risk-standardized AMI hospitalization and mortality rates varied by county-based median income level. DESIGN, SETTING, AND PARTICIPANTS In this observational study, county-level risk-standardized (age, sex, and race) hospitalization and 1-year mortality rates for AMI from January 1, 1999, to December 31, 2013, were measured for Medicare beneficiaries 65 years or older. Data analysis was performed from June 2 through December 1, 2015. Counties were stratified by median income percentile using 1999 US Census Bureau data adjusted for inflation: low- (<25th), average- (25th-75th), or high- (>75th) income groups. MAIN OUTCOMES AND MEASURES The effect of income on the slope of AMI hospitalizations and mortality, measured as differences in the rate of change in AMI hospitalizations and mortality by county income and by the 4 US geographic regions, and a possible lag effect among low-income counties. RESULTS In the 15-year study period, AMI risk-standardized hospitalization and mortality rates decreased significantly for all 3 county income groups. Mean hospitalization rates were significantly higher among low-income counties compared with high-income counties in 1999 (1353 vs 1123 per 100 000 person-years, respectively) and in 2013 (853 vs 648 per 100 000 person-years, respectively). One-year mortality rates after hospitalization for AMI were similar across county income groups, decreasing from 1999 (31.5%, 31.4%, and 31.1%, for high-, average-, and low-income counties, respectively) to 2013 (26.2%, 26.1%, and 25.4%, respectively). Income was associated with county-level, risk-standardized AMI hospitalization rates but not mortality rates. Increasing 1 interquartile range of median county consumer price index-adjusted income ($12 000) was associated with a decline in 46 and 37 hospitalizations per 100 000 person-years for 1999 and 2013, respectively; interaction between income and time was 0.56. The rate of decline in AMI hospitalizations was similar for all county income groups; however, low-income counties lagged behind high-income counties by 4.3 (95% CI, 3.1-5.9) years. There were no significant differences in trends across geographic regions. CONCLUSIONS AND RELEVANCE Hospitalization and mortality rates of AMI declined among counties of all income levels, although hospitalization rates among low-income counties lag behind those of the higher income groups. These findings lend support for a more targeted, community-based approach to AMI prevention.
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Affiliation(s)
- Erica S Spatz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut2Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | | | - Yun Wang
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut2Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut4Department of Biostatistics, Harva
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut2Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut2Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut5Department of Health Policy and Ma
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Iyngkaran P, Beneby GS. Toward phase 4 trials in heart failure: A social and corporate responsibility of the medical profession. World J Methodol 2015; 5:179-184. [PMID: 26713277 PMCID: PMC4686414 DOI: 10.5662/wjm.v5.i4.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 09/07/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
Congestive heart failure (CHF) is a chronic condition, requiring polypharmacy, allied health supports and regular monitoring. All these factors are needed to ensure compliance and to deliver the positive outcomes demonstrated from randomized controlled trials. Unfortunately many centers around the world are unable to match trial level support. The outcomes for many communities are thus unclear. Research design factors in post-marketing surveillance to address this issue. Phase 4 studies is the name given to trials designed to obtain such community level data and thus address issues of external validity. CHF phase 4 studies are relatively underutilized. We feel the onus for this research lies with the health profession. In this commentary we provide arguments as to why phase 4 studies should be viewed as a social and corporate responsibility of health professional that care for clients with CHF.
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Bradley EH, Sipsma H, Brewster AL, Krumholz HM, Curry L. Strategies to reduce hospital 30-day risk-standardized mortality rates for patients with acute myocardial infarction: a cross-sectional and longitudinal survey. BMC Cardiovasc Disord 2014; 14:126. [PMID: 25252826 PMCID: PMC4182840 DOI: 10.1186/1471-2261-14-126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/17/2014] [Indexed: 11/16/2022] Open
Abstract
Background Survival rates after acute myocardial infarction (AMI) vary markedly across U.S. hospitals. Although substantial efforts have been made to improve hospital performance, we lack contemporary evidence about changes in hospital strategies and features of organizational culture that might contribute to reducing hospital AMI mortality rates. We sought to describe current use of several strategies and features of organizational culture linked to AMI mortality in a national sample of hospitals and examine changes in use between 2010 and 2013. Methods We conducted a cross-sectional survey of 543 hospitals (70% response rate) in 2013, and longitudinal analysis of a subsample of 107 hospitals that had responded to a survey in 2010 (67% response rate). Results Between 2010 and 2013, the use of many strategies increased, but the use of only two strategies increased significantly: the percentage of hospitals providing regular training to Emergency Medical Service (EMS) providers about AMI care increased from 36% to 71% (P-value < 0.001) and the percentage of hospitals using computerized assisted physician order entry more than doubled (P-value < 0.001). Most, but not all, hospitals reported having environments conducive to communication, coordination and problem solving. Conclusions We found few significant changes between 2010 and 2013 in hospital strategies or in key features of organizational culture that have been associated with lower AMI mortality rates. Findings highlight several opportunities to help close remaining performance gaps in AMI mortality among hospitals. Electronic supplementary material The online version of this article (doi:10.1186/1471-2261-14-126) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elizabeth H Bradley
- Department of Health Policy and Management, Yale School of Public Health, 60 College Street, PO Box 208034, New Haven, CT 06520-8034, USA.
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Sorita A, Ahmed A, Starr SR, Thompson KM, Reed DA, Prokop L, Shah ND, Murad MH, Ting HH. Off-hour presentation and outcomes in patients with acute myocardial infarction: systematic review and meta-analysis. BMJ 2014; 348:f7393. [PMID: 24452368 PMCID: PMC3898160 DOI: 10.1136/bmj.f7393] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the association between off-hour (weekends and nights) presentation, door to balloon times, and mortality in patients with acute myocardial infarction. DATA SOURCES Medline in-process and other non-indexed citations, Medline, Embase, Cochrane Database of Systematic Reviews, and Scopus through April 2013. STUDY SELECTION Any study that evaluated the association between time of presentation to a healthcare facility and mortality or door to balloon times among patients with acute myocardial infarction was included. DATA EXTRACTION Studies' characteristics and outcomes data were extracted. Quality of studies was assessed with the Newcastle-Ottawa scale. A random effect meta-analysis model was applied. Heterogeneity was assessed using the Q statistic and I(2). RESULTS 48 studies with fair quality, enrolling 1,896,859 patients, were included in the meta-analysis. 36 studies reported mortality outcomes for 1,892,424 patients with acute myocardial infarction, and 30 studies reported door to balloon times for 70,534 patients with ST elevation myocardial infarction (STEMI). Off-hour presentation for patients with acute myocardial infarction was associated with higher short term mortality (odds ratio 1.06, 95% confidence interval 1.04 to 1.09). Patients with STEMI presenting during off-hours were less likely to receive percutaneous coronary intervention within 90 minutes (odds ratio 0.40, 0.35 to 0.45) and had longer door to balloon time by 14.8 (95% confidence interval 10.7 to 19.0) minutes. A diagnosis of STEMI and countries outside North America were associated with larger increase in mortality during off-hours. Differences in mortality between off-hours and regular hours have increased in recent years. Analyses were associated with statistical heterogeneity. CONCLUSION This systematic review suggests that patients with acute myocardial infarction presenting during off-hours have higher mortality, and patients with STEMI have longer door to balloon times. Clinical performance measures may need to account for differences arising from time of presentation to a healthcare facility.
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Affiliation(s)
- Atsushi Sorita
- Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA
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