Rural-urban disparity in survival and use of PCI in patients who develop STEMI while hospitalized for a non-cardiac
Ryan Searcy1, Rajiv Patel1, Peter Drossopoulos1
1Division of Cardiology and the McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, USA.
Insights
Patients experiencing ST-segment elevation myocardial infarction (STEMI) while hospitalized for other reasons face higher mortality. Rural hospitals and lower percutaneous coronary intervention (PCI) volumes are linked to reduced PCI use and increased one-year mortality for these STEMI patients.
Area of Science:
- Cardiology
- Health Services Research
- Public Health
Background:
- ST-segment elevation myocardial infarction (STEMI) in patients hospitalized for non-cardiac conditions is associated with high mortality.
- Inpatient STEMI (IPS) presents unique challenges compared to outpatient STEMI (OPS).
Purpose of the Study:
- To investigate the impact of hospital location (rural vs. urban) and percutaneous coronary intervention (PCI) volumes on clinical outcomes for patients with inpatient STEMI.
- To compare outcomes between inpatient STEMI (IPS) and outpatient STEMI (OPS).
Main Methods:
- Utilized the New York Statewide Planning and Research Cooperative System database (2011-2018) for STEMI claims.
- Classified hospitals as urban or rural using the 2010 Rural-Urban Commuting Area (RUCA) scheme.
- Analyzed clinical outcomes, including PCI rates and one-year mortality, based on hospital characteristics and PCI volume.
Main Results:
- Inpatient STEMI (IPS) patients were older, more frequently female, had more comorbidities, received PCI less often, and had significantly higher one-year mortality than outpatient STEMI (OPS) patients.
- IPS patients treated at rural hospitals showed lower PCI rates and higher one-year mortality compared to those at urban hospitals.
- Admission to low-volume PCI centers was associated with reduced PCI likelihood and increased one-year mortality for IPS patients, even after adjusting for patient factors.
Conclusions:
- Inpatient STEMI patients treated at rural hospitals or low-volume PCI centers are less likely to receive timely PCI and experience worse one-year survival.
- Hospital location and PCI procedural volume are critical determinants of outcomes for inpatient STEMI.
- Strategies to improve access to PCI in rural and low-volume centers are needed to reduce mortality for inpatient STEMI.
Background:
The development of ST-segment elevation myocardial infarction (STEMI) in patients hospitalized for non-cardiac indications carries a high mortality rate.
Objectives:
Determine the impact of rural vs. urban hospital location and hospital percutaneous coronary intervention (PCI) volumes on clinical outcomes.
Methods:
The New York Statewide Planning and Research Cooperative System database was queried for STEMI claims from 2011 to 2018. The 2010 Rural-Urban Commuting Area classification scheme was used to stratify hospitals as urban or rural.
Results:
64960 STEMI patients were identified from 231 hospitals with 2880 (4.4%) being classified as inpatient STEMI (IPS). IPS patients were older (73.5 ± 13.3 years vs 64.6 ± 14.2 years; p < .0001) and more frequently female (49.3% vs 33.1%; p < .0001), had more comorbidities, were less likely to receive PCI (13.1% vs 69.4%; p < .0001), and had higher 1-year mortality (59.6% vs 16.4%; p < .0001) than outpatient STEMI (OPS). IPS that occurred in rural hospitals were less often treated with PCI (3.8% vs 13.8%; p < 0.01) and had higher one-year mortality (68.6% vs 58.9%; p < 0.01) than those occurring in urban hospitals. Similar results were observed when hospitals were divided into rural vs suburban vs urban based on the 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties. Patients with IPS admitted to low-volume PCI centers were significantly less likely to receive PCI and had higher one-year mortality, after adjustment for demographics and comorbidities, compared to those admitted to high-volume PCI centers.
Conclusions:
IPS treated at rural hospitals and/or low-volume PCI centers were less likely to be treated with PCI and had higher one-year mortality rates.
Unstructured Abstract:
The development of ST-Segment Elevation Myocardial Infarction (STEMI) in patients hospitalized for non-cardiac indications carries a high mortality rate. Using a large retrospective cohort study, we investigated the impact of hospital location and PCI volume on outcomes in inpatient STEMI (IPS). Patients with IPS were generally older, more frequently female, and had more comorbidities than those with outpatient STEMI. After adjustment for demographics and comorbidities, those with IPS admitted to rural and/or low-volume PCI centers were less likely to receive PCI and experienced higher one-year mortality rates.
More Related Videos
06:10Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:29Cardiomyopathy V: Interprofessional Care