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Characteristics of High-Performing Hospitals in Cardiogenic Shock Following Acute Myocardial Infarction

Saha, Amit ; Li, Shuang ; de Lemos, James A. ; Pandey, Ambarish ; Bhatt, Deepak L. ; Fonarow, Gregg C. ; Nallamothu, Brahmajee K. ; Wang, Tracy Y. ; Navar, Ann Marie ; Peterson, Eric ; Matsouaka, Roland A. ; Bavry, Anthony A. ; Das, Sandeep R. ; Grodin, Justin L. ; Khera, Rohan ; Drazner, Mark H. ; Kumbhani, Dharam J.

The American journal of cardiology, 2024-06, Vol.221, p.19-28 [Periódico revisado por pares]

United States: Elsevier Inc

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Título:
Characteristics of High-Performing Hospitals in Cardiogenic Shock Following Acute Myocardial Infarction
Autor: Saha, Amit ; Li, Shuang ; de Lemos, James A. ; Pandey, Ambarish ; Bhatt, Deepak L. ; Fonarow, Gregg C. ; Nallamothu, Brahmajee K. ; Wang, Tracy Y. ; Navar, Ann Marie ; Peterson, Eric ; Matsouaka, Roland A. ; Bavry, Anthony A. ; Das, Sandeep R. ; Grodin, Justin L. ; Khera, Rohan ; Drazner, Mark H. ; Kumbhani, Dharam J.
Assuntos: Aged ; cardiogenic shock ; Cardiology ; Contraindications ; Creatinine ; critical care cardiology ; Female ; Heart ; Heart attacks ; Heterogeneity ; Hospital Mortality ; Hospitals ; Hospitals, High-Volume ; Humans ; Intubation ; Male ; Medicaid ; Medicare ; Middle Aged ; Mortality ; Myocardial infarction ; Myocardial Infarction - complications ; Myocardial Infarction - mortality ; Myocardial Revascularization - statistics & numerical data ; Pain ; Patients ; Registries ; Retrospective Studies ; Review boards ; Risk ; risk-adjusted mortality rate ; Shock, Cardiogenic - etiology ; Shock, Cardiogenic - mortality ; Shock, Cardiogenic - therapy ; Transplants & implants ; United States - epidemiology ; Variables ; Ventricular assist devices
É parte de: The American journal of cardiology, 2024-06, Vol.221, p.19-28
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SourceType-Scholarly Journals-1
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Descrição: Cardiogenic shock after acute myocardial infarction (AMI-CS) carries significant mortality despite advances in revascularization and mechanical circulatory support. We sought to identify the process-based and structural characteristics of centers with lower mortality in AMI-CS. We analyzed 16,337 AMI-CS cases across 440 centers enrolled in the National Cardiovascular Data Registry's Chest Pain-MI Registry, a retrospective cohort database, between January 1, 2015, and December 31, 2018. Centers were stratified across tertiles of risk-adjusted in-hospital mortality rate (RAMR) for comparison. Risk-adjusted multivariable logistic regression was also performed to identify hospital-level characteristics associated with decreased mortality. The median participant age was 66 (interquartile range 57 to 75) years, and 33.0% (n = 5,390) were women. The median RAMR was 33.4% (interquartile range 26.0% to 40.0%) and ranged from 26.9% to 50.2% across tertiles. Even after risk adjustment, lower-RAMR centers saw patients with fewer co-morbidities. Lower-RAMR centers performed more revascularization (92.8% vs 90.6% vs 85.9%, p <0.001) and demonstrated better adherence to associated process measures. Left ventricular assist device capability (odds ratio [OR] 0.78 [0.67 to 0.92], p = 0.002), more frequent revascularization (OR 0.93 [0.88 to 0.98], p = 0.006), and higher AMI-CS volume (OR 0.95 [0.91 to 0.99], p = 0.009) were associated with lower in-hospital mortality. However, several such characteristics were not more frequently observed at low-RAMR centers, despite potentially reflecting greater institutional experience or resources. This may reflect the heterogeneity of AMI-CS even after risk adjustment. In conclusion, low-RAMR centers do not necessarily exhibit factors associated with decreased mortality in AMI-CS, which may reflect the challenges in performing outcomes research in this complex population.
Editor: United States: Elsevier Inc
Idioma: Inglês

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Characteristics of High-Performing Hospitals in Cardiogenic Shock Following Acute Myocardial Infarction

United States: Elsevier Inc

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