Key result
High emergency medical supply inequality is linked to ~69% higher in-hospital post-AMI mortality.
Why the study?
The association between healthcare system factors and death from acute myocardial infarction, accounting for individual and environmental factors, was not well characterized.
Cohort (n=53,770)
Yes
Hazard Ratio: 1.689 (95% CI 1.493–1.91)
Absolute Event Rate: 20.3% vs 8.5%
p-value: p=<0.0001
May warrant efforts to address regional supply disparities; leaves open whether reducing inequality improves AMI survival.
OBJECTIVES: We conducted a cross-sectional study to assess the association between healthcare system factors and death from acute myocardial infarction (AMI), in terms of access (distance to the hospital, mode of transportation), availability (emergency medical services, hospitals), and capability (emergency medical services' 12-lead electrocardiogram capability, continuous percutaneous coronary intervention [PCI] and cardiothoracic surgical services), after accounting for individual and environmental factors. METHODS: Data on 14,663 deaths (in-hospital and out of hospital) and live hospital discharges as a result of AMI for 2012 and 2013 among Arkansas residents were obtained from the Arkansas Department of Health. A mixed-effects logistic regression model was used to account for nesting, in which an individual was nested within either a county or a hospital to evaluate the association of system factors with death from AMI. RESULTS: Deaths from AMI were significantly associated with two system factors: a 9.2% increase in the odds of deaths from AMI for every 10-mi increase in distance to the nearest hospital (odds ratio 1.092, 95% confidence interval 1.009-1.181) and a 64% increase in the odds of death from AMI among hospitals without continuous PCI capability (odds ratio 1.64, 95% confidence interval 1.15-2.34), after adjusting for individual and environmental factors. CONCLUSIONS: A higher risk of AMI deaths was associated with healthcare system factors, especially distance to nearest hospital, and hospitals' continuous PCI capability, even after adjusting for individual and environmental factors. A coordinated system of care approaches that mitigates gaps in these system factors may prevent death from AMI.
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Balamurugan et al. (2018) conducted a cohort in Acute Myocardial Infarction (n=53,770). High inequality in regional emergency medical supply resources (index ≥0.75) vs. Low inequality in regional emergency medical supply resources (index <0.25) was evaluated on All-cause in-hospital mortality (HR 1.689, 95% CI 1.493-1.910, p=<0.0001). Residing in regions with a high inequality index for emergency medical supply resources (≥0.75) was associated with a significantly increased risk of in-hospital mortality following acute myocardial infarction compared to regions with an index <0.25 (HR 1.689).
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