Hospital-Level Disparities in the Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction

Area of Science:

• Cardiology
• Health Services Research
• Critical Care Medicine

Background:

• Limited contemporary data exist on how hospital characteristics influence outcomes for patients experiencing cardiac arrest complicating acute myocardial infarction (AMI-CA).
• Understanding these relationships is crucial for optimizing care delivery and improving survival rates in this high-risk patient population.

Purpose of the Study:

• To evaluate the association between hospital characteristics (location, teaching status, bed size) and in-hospital outcomes for patients with AMI-CA.
• To identify disparities in care, such as the utilization of cardiac and non-cardiac procedures, based on hospital type and size.

Main Methods:

• Utilized the National Inpatient Sample database from 2000 to 2017 to identify adult admissions with primary diagnosis of AMI and concomitant CA.
• Excluded interhospital transfers and classified hospitals by location/teaching status (rural, urban nonteaching, urban teaching) and bed size (small, medium, large).
• Analyzed rates of procedures and in-hospital mortality, adjusting for patient factors.

Main Results:

• Among 494,083 AMI-CA admissions, rural hospitals provided care to 9.3%, urban nonteaching to 43.4%, and urban teaching to 47.3%.
• Rural hospitals had lower rates of cardiac and non-cardiac procedures compared to urban facilities. Urban teaching hospitals showed higher rates of acute organ failure and cardiogenic shock.
• In-hospital mortality was higher in urban nonteaching (aOR 1.17) and urban teaching hospitals (aOR 1.36) versus rural hospitals. Medium and large hospitals were associated with higher mortality than small hospitals.

Conclusions:

• Hospital location, teaching status, and bed size are significantly associated with outcomes for patients with AMI-CA.
• Admissions to large and urban hospitals demonstrated higher in-hospital mortality, potentially reflecting greater patient acuity in these settings.
• Findings highlight potential disparities in care and outcomes based on hospital characteristics, warranting further investigation and targeted interventions.