Elsevier

The American Journal of Cardiology

Volume 159, 15 November 2021, Pages 30-35
The American Journal of Cardiology

In-Hospital Mortality for Inpatient Percutaneous Coronary Interventions in the United States

https://doi.org/10.1016/j.amjcard.2021.08.018Get rights and content

Cardiovascular mortality is substantially higher in rural communities compared with urban communities. Understanding if disparities in inpatient percutaneous coronary intervention (PCI) persist in the United States will help inform initiatives to improve cardiovascular health. Of the more than 7 million hospitalizations in the National Inpatient Sample (2016), we identified 80,793 unweighted hospitalizations for PCI using ICD-10 procedure codes. Using survey weights, these hospitalizations projected 371,040 US admissions for inpatient PCI. For the primary analysis, we determined the association between hospital urban-rural designation and in-hospital mortality after inpatient PCI. In the secondary analysis, we evaluated the association between teaching status and this outcome. Multivariable logistic regression models, adjusted for multiple risk factors and patient characteristics, were used. Of the 371,430 hospitalizations for inpatient PCI, there were 108.9 (±2.2) admissions per 100,000 US population from urban hospitals and 152.9 (±6.3) from rural hospitals. Of the urban hospitals, there were 77.7 (±1.9) admissions per 100,000 US population at teaching hospitals (71.7%) and 30.7 (±1.0) at urban nonteaching hospitals (28.3%). In-hospital mortality did not differ between urban and rural hospitals (1.8% urban vs 1.9% rural, adjusted odds ratio for rural compared with urban: 1.15 [95% confidence interval 0.98, 1.34], p = 0.08). In urban hospitals, however, in-hospital mortality was higher in nonteaching hospitals than in teaching hospitals (2.0% nonteaching vs 1.7% teaching, adjusted odds ratio for teaching compared with nonteaching: 1.17 [95% confidence interval 1.01, 1.36], p = 0.04). In conclusion, in-hospital mortality rates after inpatient PCI were similar between urban and rural hospitals in the United States. However, among urban hospitals, nonteaching hospitals had higher rates of in-hospital mortality after PCI. In conclusion, solutions to address disparities for inpatient PCI outcomes between teaching and nonteaching hospitals are needed.

Section snippets

Methods

We used the 2016 National Inpatient Sample (NIS) database developed for the Healthcare Cost and Utilization Project by the Agency for Healthcare Research and Quality.14 This is a publicly available all-payer inpatient healthcare database that includes data from more than 7 million hospital stays annually and is designed to project nationally representative estimates of US inpatient hospitalizations. NIS excluded rehabilitation and long-term care facilities.

The 2016 NIS database included

Results

We identified 80,793 unweighted inpatient hospitalizations for PCI, which project 371,430 (±7,175) US admissions for PCI. The average age for this population was 64.8 (±0.07) years, with 248,830 (±4,900) admissions for men (67.0%) and 122,600 (±2,443) admissions for women (33.0%).

Of the 371,430 admissions, there were 108.9 (±2.2) admissions per 100,000 US population from urban hospitals and 152.9 (±6.3) per 100,000 US population from rural hospitals (Figure 1). The average age for patients

Discussion

We find that rural and urban hospitals have similar rates of in-hospital mortality after inpatient PCI. As rural hospitals previously had higher in-hospital mortality-rates, this demonstrates a substantial improvement in PCI care. However, we did find that within urban centers substantial differences in care exist—with nonteaching hospitals having substantially higher rates of mortality. 41% of urban inpatient hospitalizations for PCI were for NSTEMI events and 3% for STEMI events, compared

Disclosures

The authors have no competing interests to report.

Acknowledgment

We would like to acknowledge HCUP and their partners for their contributions to the NIS database. A full list of partners can be found at https://www.hcup-us.ahrq.gov/db/hcupdatapartners.jsp.

References (29)

  • AK. Jacobs et al.

    Development of systems of care for ST-Elevation myocardial infarction patients

    Circulation

    (2007)
  • RA. Harrington et al.

    Call to action: rural health: a presidential advisory from the American Heart Association and American Stroke Association

    Circulation

    (2020)
  • N Villapiano et al.

    Worsening rural-urban gap in hospital mortality

    J Am Board Fam Med JABFM

    (2017)
  • ND Brunetti et al.

    Pre-hospital electrocardiogram triage with tele-cardiology support is associated with shorter time-to-balloon and higher rates of timely reperfusion even in rural areas: data from the Bari- Barletta/Andria/Trani public emergency medical service 118 registry on primary angioplasty in ST-elevation myocardial infarction

    Eur Heart J Acute Cardiovasc Care

    (2014)
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      Citation Excerpt :

      On the other hand, those with cardiac arrest complicating AMI appeared to be fare better in rural centres than in urban teaching hospitals (In-hospital mortality aOR 1.36, 95 % CI 1.32–1.39, p < 0.001) in another NIS study [7], however this is likely due to more severe cases surviving to hospital presentation in the urban compared to the rural settings as discussed above. A recently published analysis from the 2016 NIS database found no difference in adjusted in-hospital mortality between rural and urban centres following PCI [16]. However, there are three caveats in comparison to this paper.

    Funding: No funding was used for this study.

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