Association between hospital characteristics and 30-day mortality of patients hospitalized for acute myocardial infarction in Sichuan, China.
J Evid Based Med
; 15(3): 236-244, 2022 Sep.
Article
en En
| MEDLINE
| ID: mdl-36018065
ABSTRACT
OBJECTIVE:
Because acute myocardial infarction (AMI) is a major cause of death, China faces the challenge of improving its quality of care. This study provides context-specific evidence of association between 30-day mortality and hospital characteristics in China to extend the understanding of hospitalized AMI patients.METHODS:
We conducted a retrospective cohort study of 67,619 hospitalized AMI patients at 372 tertiary and secondary hospitals in Sichuan, China, between January 1, 2018 and December 31, 2020. Using a hierarchical logistic regression model to control risk factors, we explored relationships among 30-day mortality, hospital level, AMI volume, and percutaneous coronary intervention (PCI) timeliness. Locally weighted scatterplot smoothing was used to observe the trends of 30-day mortality with increased AMI volume and PCI timeliness.RESULTS:
After risk factor adjustment, the 30-day mortality model demonstrated that a lower hospital level and smaller AMI volume were associated with higher 30-day mortality (medium-volume OR = 1.511, 95% CI (1.195, 1.910); small-volume OR = 1.636, 95% CI (1.277, 2.096); other tertiary OR = 1.190, 95% CI (1.037, 1.365); secondary OR = 1.524, 95% CI (1.289, 1.800)). Similarly, 30-day mortality was higher for patients at hospitals with a low PCI timeliness (low timeliness OR = 1.318, 95% CI (1.079, 1.610)). Scatterplot smoothing showed hospital 30-day mortality first reduced quickly and gradually stabilized with increased AMI volume and PCI timeliness.CONCLUSION:
Patients admitted to tertiary grade A hospitals, large-volume hospitals, and high- or medium-timeliness hospitals were more likely to survive at 30 days. Policymakers should focus on improving the outcomes at hospitals without these characteristics.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Intervención Coronaria Percutánea
/
Infarto del Miocardio
Tipo de estudio:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Humans
Idioma:
En
Revista:
J Evid Based Med
Año:
2022
Tipo del documento:
Article