Key result
Treatment of acute myocardial infarction in safety-net hospitals was associated with increased major adverse cardiovascular/cerebrovascular events (aOR 1.11; 95% CI 1.09-1.12; p<0.001).
Why the study?
Safety-net hospitals manage more uninsured patients and are often in deprived areas, but whether clinical characteristics, treatments, and outcomes differ for acute myocardial infarction patients between safety-net and non-safety-net hospitals was unclear.
Does treatment in safety-net hospitals worsen clinical outcomes and reduce invasive management in patients with acute myocardial infarction compared to non-safety-net hospitals?
Observational (n=2,544,009)
Yes
Does treatment in safety-net hospitals worsen clinical outcomes and reduce invasive management in patients with acute myocardial infarction compared to non-safety-net hospitals?
Odds Ratio: 1.11 (95% CI 1.09–1.12)
p-value: p=<0.001
Treatment of acute myocardial infarction in safety-net hospitals is associated with lower rates of invasive revascularization and worse in-hospital clinical outcomes, highlighting significant healthcare disparities.
AIM: Safety-net hospitals (SNHs) look after a higher proportion of uninsured patients and are often located in deprived areas. This study aimed to determine whether there are differences in the clinical characteristics, treatments and outcomes of patients presenting with acute myocardial infarction (AMI) in SNHs versus non-SNHs (N-SNHs). METHODS: All hospitalizations with a principal diagnosis of AMI in the United States' National Inpatient Sample between 2016 and 2019 were stratified by safety-net hospital status. Multivariable logistic regression with adjusted odds ratios (aOR) and 95 % confidence intervals (95 % CI) was conducted to investigate invasive management and clinical outcomes. RESULTS: A total of 2,544,009 weighted discharge records were analyzed, including 601,719 records from SNHs (23.7 %). Compared with N-SNHs, SNH AMI patients were younger (median 66 years vs. 67 years, p < 0.001), and had a higher proportion in the lowest quartile of median household income (37.3 % vs. 28.5 %, p < 0.001). Patients from SNHs were less likely to receive coronary angiography (aOR 0.92, 95 % CI 0.91-0.93, p < 0.001), percutaneous coronary intervention (aOR 0.94, 95 % CI 0.93-0.95, p < 0.001), and coronary artery bypass grafting (aOR 0.93, 95 % CI 0.92-0.94, p < 0.001). In addition, they had increased all-cause mortality (aOR 1.11, 95 % CI 1.09-1.12, p < 0.001), major adverse cardiovascular/cerebrovascular events (composite of mortality, stroke and reinfarction) (aOR 1.11, 95 % CI 1.09-1.12, p < 0.001), and stroke (aOR 1.11, 95 % CI 1.08-1.14, p < 0.001), while there was no difference in major bleeding (aOR 1.02, 95 % CI 1.00-1.04, p = 0.107). CONCLUSION: Among AMI patients, treatment in SNHs was associated with lower utilization of coronary angiography and revascularization and worse clinical outcomes.
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Bashar et al. (2022) conducted an observational in acute myocardial infarction (n=2,544,009). Treatment in safety-net hospitals vs. Non-safety-net hospitals was evaluated on major adverse cardiovascular/cerebrovascular events (composite of mortality, stroke and reinfarction) (aOR 1.11, 95% CI 1.09-1.12, p=<0.001). Treatment of acute myocardial infarction in safety-net hospitals was associated with increased major adverse cardiovascular/cerebrovascular events (aOR 1.11; 95% CI 1.09-1.12; p<0.001).
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