Number of Cardiologists per Cardiovascular Beds and In‐Hospital Mortality for Acute Heart Failure: A Nationwide Study in Japan
Key result
Admission to hospitals with the highest quartile of cardiologists per cardiovascular beds was associated with lower in-hospital mortality for acute heart failure (OR 0.70; 95% CI 0.61-0.80; P<0.001).
Why the study?
Little evidence is available regarding the number of cardiologists required for appropriate treatment of heart failure.
Does a higher ratio of cardiologists to cardiovascular beds reduce in-hospital mortality in patients admitted for acute heart failure?
Population
154 290 patients with HF on emergency admission in Japan
Comparison
Four quartiles of cardiologists per 50 cardiovascular beds
Design
Nationwide cross-sectional registry-based study
Authors
Discussion
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Member takes
Implication
Higher cardiologist density was associated with lower acute HF mortality; leaves open whether staffing changes improve outcomes.
Key Points
- To determine the relationship between the number of cardiologists per cardiovascular beds and in-hospital mortality for acute heart failure.
- Cross-sectional study utilizing the Japanese Registry of All Cardiac and Vascular Diseases discharge database.
- Analyzed data from 154,290 emergency admissions for acute heart failure from April 2012 to March 2014.
- Used multilevel mixed-effect logistic regression to calculate adjusted odds ratios for in-hospital mortality.
- In-hospital mortality odds ratios were 0.82 (P<0.001) and 0.70 (P<0.001) for hospitals with more cardiologists compared to the baseline group.
- Patients in hospitals with higher cardiologist-to-bed ratios had a greater proportion of medication use related to heart failure treatment.
- Mortality decreased with an increasing number of cardiologists per cardiovascular beds.
Study Design
Type
Cross-Sectional (n=154,290)
Multicenter
Yes
Structured PICO
Does a higher ratio of cardiologists to cardiovascular beds reduce in-hospital mortality in patients admitted for acute heart failure?
P
Population
154,290 patients with heart failure on emergency admission in Japan, evaluated for the association between the number of cardiologists per cardiology beds and in-hospital mortality.
E
Exposure
Treatment in hospitals with higher numbers of cardiologists per 50 cardiovascular beds (quartiles 2-4: medians 6.7, 9.7, and 16.7).
C
Comparator
Treatment in hospitals with the lowest quartile of cardiologists per 50 cardiovascular beds (first group: median 4.4).
O
Outcome
In-hospital mortalityhard clinical
Main Result
Odds Ratio: 0.7 (95% CI 0.61–0.8)
p-value: p=<0.001
A higher ratio of cardiologists to cardiovascular beds is associated with significantly lower in-hospital mortality and higher rates of guideline-directed medical therapy for acute heart failure.
Cite This Study
Kanaoka et al. (2019) conducted a cross-sectional in Acute heart failure (n=154,290). Higher number of cardiologists per cardiovascular beds vs. Lowest quartile of cardiologists per 50 cardiovascular beds was evaluated on In-hospital mortality (OR 0.70, 95% CI 0.61-0.80, p=<0.001). Admission to hospitals with the highest quartile of cardiologists per cardiovascular beds was associated with lower in-hospital mortality for acute heart failure (OR 0.70; 95% CI 0.61-0.80; P<0.001).