Association Between System Factors and Acute Myocardial Infarction Mortality. Issue 9 (September 2018) - Balamurugan, Appathurai
Abstract : 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. Abstract : Acute myocardial infarction (AMI) is a leading cause of death among men and women in the United States. According to the Centers for Disease Control and Prevention, every year 735, 000 Americans have an AMI. There are evidence-based public health strategies that could be implemented to avert AMI mortality. The authors describe the association between healthcare system factors and AMI mortality and offer some practical recommendations to mitigate the burden.