Abstract 14624: In-Hospital Case-Fatality Rates and Associated Factors Among Patients with Acute Myocardial Infarction in Beijing During 2007-2009
Background: In-hospital case-fatality rates in patients admitted for acute myocardial infarction (AMI) are widely used as a quality indicator. Although substantial advances have been made in AMI treatment in Beijing, recent in-hospital case-fatality rates and associated factors are not available at the city-level.
Objective: To assess the recent in-hospital case-fatality rates of AMI and associated factors in Beijing.
Methods: We analyzed data from Hospital Discharge Information System, which covers all hospital admissions in Beijing, except those admitted in military hospitals. Patients who were admitted in hospitals during Jan. 1, 2007, to Dec. 31, 2009, with an AMI in the primary diagnosis field were extracted. We assessed in-hospital case- fatality and impacts of associated factors, including demographic factors, health insurance, comorbidity, cardiac procedure use, and hospital levels.
Results: Totally 35,486 patients among the permanent residences in Beijing and aged 25 years or more were identified. The mean (±standard deviation) age was 65.6 (±12.9) years, and 68.2% were men. The in-hospital case-fatality for AMI was 10.0% (9.3% for men and 11.5% for women, P<0.01). During 2007-2009, case-fatality declined by 11.0% in men and 10.5% in women. Declines were noticed in older age groups (55 years and over), but not in younger groups (25-54 years). The rates declined by 15.7%, 10.2% and 3.9%, respectively, in urban, suburban, and exurban area. In multivariate Logistic regression, elder age, female gender, divorce, concomitant diseases, and being admitted in lower level hospitals in urban and suburban areas significantly increased the risk of in-hospital death. Coronary Artery By-pass Grafting (CABG) and percutaneous intervention (PCI) significantly reduced the risk, with an odds ratio of 0.73 (95%CI 0.55-0.96, P=0.024) for CABG and 0.17 (95%CI 0.15-0.20, P<0.001) for PCI.
Conclusion: A substantial decline in the in-hospital case-fatality for AMI occurred in Beijing, supporting improvements in the in-hospital treatments of AMI. However, less favorable changes were found in younger patients and patients in exurban area. The present data may guide future health care planning and help to determine priorities for clinical treatment..
- © 2011 by American Heart Association, Inc.