Tanush Gupta1, Kavisha Patel2, Dhaval Kolte3, Sahil Khera4, Pedro A Villablanca5, Wilbert S Aronow6, William H Frishman6, Howard A Cooper6, Anna E Bortnick1, Gregg C Fonarow7, Julio A Panza6, Giora Weisz1, Mark A Menegus1, Mario J Garcia1, Deepak L Bhatt8. 1. Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 2. Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY. 3. Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI. 4. Division of Cardiology, Massachusetts General Hospital, Boston. 5. Division of Cardiology, New York University Langone Medical Center, New York. 6. Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla. 7. Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles. 8. Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA. Electronic address: dlbhattmd@post.harvard.edu.
Abstract
BACKGROUND: Prior analyses have largely shown a survival advantage with admission to a teaching hospital for acute myocardial infarction. However, most prior studies report data on patients hospitalized over a decade ago. It is important to re-examine the association of hospital teaching status with outcomes of acute myocardial infarction in the current era. METHODS: We queried the 2010 to 2014 National Inpatient Sample databases to identify all patients aged ≥18 years hospitalized with the principal diagnosis of ST-segment elevation myocardial infarction (STEMI). Multivariable logistic regression models were constructed to compare rates of reperfusion and in-hospital outcomes between patients admitted to teaching vs nonteaching hospitals. RESULTS: Of 546,252 patients with STEMI, 273,990 (50.1%) were admitted to teaching hospitals. Compared with patients admitted to nonteaching hospitals, those at teaching hospitals were more likely to receive reperfusion therapy during the hospitalization (86.7% vs 81.5%; adjusted odds ratio [OR] 1.41; 95% confidence interval [CI], 1.39-1.44; P < .001) and had lower risk-adjusted in-hospital mortality (4.9% vs 6.9%; adjusted OR 0.84; 95% CI, 0.82-0.86; P < .001). After further adjustment for differences in use of in-hospital reperfusion therapy, the association of teaching hospital status with lower risk-adjusted in-hospital mortality was significantly attenuated but remained statistically significant (adjusted OR 0.97; 95% CI, 0.94-0.99; P = .02). CONCLUSIONS: Patients admitted to teaching hospitals are more likely to receive reperfusion and have lower risk-adjusted in-hospital mortality after STEMI compared with those admitted to nonteaching hospitals. Our results suggest that hospital performance for STEMI continues to be better at teaching hospitals in the contemporary era.
BACKGROUND: Prior analyses have largely shown a survival advantage with admission to a teaching hospital for acute myocardial infarction. However, most prior studies report data on patients hospitalized over a decade ago. It is important to re-examine the association of hospital teaching status with outcomes of acute myocardial infarction in the current era. METHODS: We queried the 2010 to 2014 National Inpatient Sample databases to identify all patients aged ≥18 years hospitalized with the principal diagnosis of ST-segment elevation myocardial infarction (STEMI). Multivariable logistic regression models were constructed to compare rates of reperfusion and in-hospital outcomes between patients admitted to teaching vs nonteaching hospitals. RESULTS: Of 546,252 patients with STEMI, 273,990 (50.1%) were admitted to teaching hospitals. Compared with patients admitted to nonteaching hospitals, those at teaching hospitals were more likely to receive reperfusion therapy during the hospitalization (86.7% vs 81.5%; adjusted odds ratio [OR] 1.41; 95% confidence interval [CI], 1.39-1.44; P < .001) and had lower risk-adjusted in-hospital mortality (4.9% vs 6.9%; adjusted OR 0.84; 95% CI, 0.82-0.86; P < .001). After further adjustment for differences in use of in-hospital reperfusion therapy, the association of teaching hospital status with lower risk-adjusted in-hospital mortality was significantly attenuated but remained statistically significant (adjusted OR 0.97; 95% CI, 0.94-0.99; P = .02). CONCLUSIONS:Patients admitted to teaching hospitals are more likely to receive reperfusion and have lower risk-adjusted in-hospital mortality after STEMI compared with those admitted to nonteaching hospitals. Our results suggest that hospital performance for STEMI continues to be better at teaching hospitals in the contemporary era.
Authors: Mohammad Aldiabat; Yazan Aljabiri; Mohannad H Al-Khateeb; Mubarak H Yusuf; Yassine Kilani; Ali Horoub; Fnu Farukhuddin; Ratib Mahfouz; Adham E Obeidat; Mohammad Darweesh; Mahmoud M Mansour Journal: Cureus Date: 2022-06-24