美国农村医院急性心肌梗死患者死亡率、诊断性冠状动脉造影及经皮冠状动脉介入治疗的周末效应分析
Analysis of the Weekend Effect on Mortality, Diagnostic Coronary Angiography, and Percutaneous Coronary Intervention in Acute Myocardial Infarction Across Rural US Hospitals.
作者信息
Baig Mirza Faris Ali
机构信息
Internal Medicine, Asante Three Rivers Medical Center, Grants Pass, USA.
出版信息
Cureus. 2024 Feb 7;16(2):e53751. doi: 10.7759/cureus.53751. eCollection 2024 Feb.
BACKGROUND
Rural hospitals face several unique challenges in delivering healthcare to an underserved population. Achieving time-sensitive goals in a resource-scarce facility is often a difficult task without the right team at hand. Resources are further depleted on the weekends, exposing understaffed hospitals to poorer outcomes. Acute myocardial infarction (AMI) mortality depends on timely diagnosis and intervention. It is unknown to what extent resource shortages impact rural hospitals during weekends and how they affect AMI mortality.
METHODS
This cross-sectional study was performed on patients admitted on weekends with AMI using the National Inpatient Sample (NIS) 2019. Patients with type II non-ST-elevation myocardial infarction (NSTEMI) and missing information were excluded. The rates and timing of in-hospital diagnostic coronary angiograms, PCIs (percutaneous coronary interventions), and in-hospital mortality were studied. Regression models were used for data analyses.
RESULTS
A total of 161,625 patients met the inclusion criteria (58,690 females (36%), 114,830 Caucasians (71%), 17,910 African American (11%), 13,920 Hispanic (8.6%); mean (SD) age, 66.5 (0.5) years), including 47,665 (29.5%) ST-elevation myocardial infarction (STEMI) and 113,960 (70.5%) NSTEMI. Patients admitted to rural hospitals were less likely to undergo diagnostic coronary angiogram (adjusted odds ratio (aOR), 0.69; CI, 0.57-0.83; <0.001) and PCI (aOR, 0.83; CI, 0.72-0.96; 0.012). Rural hospitals had lesser odds of early diagnostic angiograms (aOR, 0.79; CI, 0.67-0.95; <0.05) and PCI (aOR, 0.78; CI, 0.66-0.92; <0.05) within 24 hours. The mortality difference between rural and urban hospitals was not significant (aOR, 1.08; CI, 0.85-1.4; 0.52).
CONCLUSIONS
Diagnostic coronary angiograms and PCI are performed at a lesser rate in rural hospitals during weekends. This trend did not affect rural AMI mortality.
背景
农村医院在为服务不足的人群提供医疗服务时面临一些独特的挑战。在资源稀缺的机构中实现对时间敏感的目标，如果没有合适的团队往往是一项艰巨的任务。周末资源会进一步耗尽，使人员配备不足的医院面临更差的治疗结果。急性心肌梗死（AMI）的死亡率取决于及时的诊断和干预。目前尚不清楚资源短缺在周末对农村医院有多大影响，以及它们如何影响AMI死亡率。
方法
本横断面研究使用2019年全国住院患者样本（NIS）对周末因AMI入院的患者进行。排除II型非ST段抬高型心肌梗死（NSTEMI）患者和信息缺失的患者。研究了院内诊断性冠状动脉造影、经皮冠状动脉介入治疗（PCI）的发生率和时间以及院内死亡率。使用回归模型进行数据分析。
结果
共有161,625名患者符合纳入标准（58,690名女性（36%），114,830名白种人（71%），17,910名非裔美国人（11%），13,920名西班牙裔（8.6%）；平均（标准差）年龄，66.5（0.5）岁），包括47,665名（29.5%）ST段抬高型心肌梗死（STEMI）和113,960名（70.5%）NSTEMI。入住农村医院的患者接受诊断性冠状动脉造影的可能性较小（调整优势比（aOR），0.69；可信区间（CI），0.57 - 0.83；<0.001）和PCI（aOR，0.83；CI，0.72 - 0.96；0.012）。农村医院在24小时内进行早期诊断性血管造影（aOR，0.79；CI，0.67 - 0.95；<0.05）和PCI（aOR，0.78；CI，0.66 - 0.92；<0.05）的几率较低。农村和城市医院之间的死亡率差异不显著（aOR，1.08；CI，0.85 - 1.4；0.52）。
结论
周末期间农村医院进行诊断性冠状动脉造影和PCI的比例较低。这一趋势并未影响农村地区AMI的死亡率。
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