Association Between Initial Admission Ward and In-Hospital Mortality Among Patients Hospitalized for Cardiovascular...

Area of Science:

• Cardiology
• Critical Care Medicine
• Health Services Research

Background:

• Limited large-scale data exists on cardiovascular emergency outcomes based on initial hospital admission ward in Japan.
• Intensive care is crucial for managing critical cardiovascular conditions.

Purpose of the Study:

• To compare in-hospital mortality rates for cardiovascular emergencies based on initial admission ward (ICU, HCU, GW).
• To investigate the association between hospital cardiologist staffing and mortality outcomes.

Main Methods:

• Analysis of the JROAD database for patients hospitalized for cardiovascular emergencies via ambulance (April 2016-March 2024).
• Classification of patients by initial admission ward: Intensive Care Unit (ICU), High Care Unit (HCU), or General Ward (GW).
• Multivariable logistic regression adjusted for demographics, comorbidities, therapies, and cardiologist staffing.

Main Results:

• In-hospital mortality was 10.8% (ICU), 9.7% (HCU), and 12.2% (GW).
• Adjusted odds of death were lower for ICU (OR 0.718) and HCU (OR 0.928) compared to GW.
• Increased board-certified cardiologists were linked to lower mortality (OR 0.977 per additional cardiologist).

Conclusions:

• Higher-acuity admission (ICU/HCU) is associated with reduced in-hospital mortality for cardiovascular emergencies.
• Increased number of cardiologists independently lowers in-hospital mortality.
• Optimizing critical care access is vital for high-risk cardiovascular emergencies in Japan.