Mortality and Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions During Dates of National Cardiology Meetings

IMPORTANCE: Thousands of physicians attend scientific meetings annually. Although hospital physician staffing and composition may be affected by meetings, patient outcomes and treatment patterns during meeting dates are unknown. OBJECTIVE: To analyze mortality and treatment differences among patient...

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Veröffentlicht in:JAMA internal medicine 2015-02, Vol.175 (2), p.237-244
Hauptverfasser: Jena, Anupam B, Prasad, Vinay, Goldman, Dana P, Romley, John
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Prasad, Vinay
Goldman, Dana P
Romley, John
description IMPORTANCE: Thousands of physicians attend scientific meetings annually. Although hospital physician staffing and composition may be affected by meetings, patient outcomes and treatment patterns during meeting dates are unknown. OBJECTIVE: To analyze mortality and treatment differences among patients admitted with acute cardiovascular conditions during dates of national cardiology meetings compared with nonmeeting dates. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of 30-day mortality among Medicare beneficiaries hospitalized with acute myocardial infarction (AMI), heart failure, or cardiac arrest from 2002 through 2011 during dates of 2 national cardiology meetings compared with identical nonmeeting days in the 3 weeks before and after conferences (AMI, 8570 hospitalizations during 82 meeting days and 57 471 during 492 nonmeeting days; heart failure, 19 282 during meeting days and 11 4591 during nonmeeting days; cardiac arrest, 1564 during meeting days and 9580 during nonmeeting days). Multivariable analyses were conducted separately for major teaching hospitals and nonteaching hospitals and for low- and high-risk patients. Differences in treatment utilization were assessed. EXPOSURES: Hospitalization during cardiology meeting dates. MAIN OUTCOMES AND MEASURES: Thirty-day mortality, procedure rates, charges, length of stay. RESULTS: Patient characteristics were similar between meeting and nonmeeting dates. In teaching hospitals, adjusted 30-day mortality was lower among high-risk patients with heart failure or cardiac arrest admitted during meeting vs nonmeeting dates (heart failure, 17.5% [95% CI, 13.7%-21.2%] vs 24.8% [95% CI, 22.9%-26.6%]; P 
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Although hospital physician staffing and composition may be affected by meetings, patient outcomes and treatment patterns during meeting dates are unknown. OBJECTIVE: To analyze mortality and treatment differences among patients admitted with acute cardiovascular conditions during dates of national cardiology meetings compared with nonmeeting dates. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of 30-day mortality among Medicare beneficiaries hospitalized with acute myocardial infarction (AMI), heart failure, or cardiac arrest from 2002 through 2011 during dates of 2 national cardiology meetings compared with identical nonmeeting days in the 3 weeks before and after conferences (AMI, 8570 hospitalizations during 82 meeting days and 57 471 during 492 nonmeeting days; heart failure, 19 282 during meeting days and 11 4591 during nonmeeting days; cardiac arrest, 1564 during meeting days and 9580 during nonmeeting days). Multivariable analyses were conducted separately for major teaching hospitals and nonteaching hospitals and for low- and high-risk patients. Differences in treatment utilization were assessed. EXPOSURES: Hospitalization during cardiology meeting dates. MAIN OUTCOMES AND MEASURES: Thirty-day mortality, procedure rates, charges, length of stay. RESULTS: Patient characteristics were similar between meeting and nonmeeting dates. In teaching hospitals, adjusted 30-day mortality was lower among high-risk patients with heart failure or cardiac arrest admitted during meeting vs nonmeeting dates (heart failure, 17.5% [95% CI, 13.7%-21.2%] vs 24.8% [95% CI, 22.9%-26.6%]; P &lt; .001; cardiac arrest, 59.1% [95% CI, 51.4%-66.8%] vs 69.4% [95% CI, 66.2%-72.6%]; P = .01). Adjusted mortality for high-risk AMI in teaching hospitals was similar between meeting and nonmeeting dates (39.2% [95% CI, 31.8%-46.6%] vs 38.5% [95% CI, 35.0%-42.0%]; P = .86), although adjusted percutaneous coronary intervention (PCI) rates were lower during meetings (20.8% vs 28.2%; P = .02). No mortality or utilization differences existed for low-risk patients in teaching hospitals or high- or low-risk patients in nonteaching hospitals. In sensitivity analyses, cardiac mortality was not affected by hospitalization during oncology, gastroenterology, and orthopedics meetings, nor was gastrointestinal hemorrhage or hip fracture mortality affected by hospitalization during cardiology meetings. CONCLUSIONS AND RELEVANCE: High-risk patients with heart failure and cardiac arrest hospitalized in teaching hospitals had lower 30-day mortality when admitted during dates of national cardiology meetings. High-risk patients with AMI admitted to teaching hospitals during meetings were less likely to receive PCI, without any mortality effect.</description><identifier>ISSN: 2168-6106</identifier><identifier>EISSN: 2168-6114</identifier><identifier>DOI: 10.1001/jamainternmed.2014.6781</identifier><identifier>PMID: 25531231</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Aged ; Aged, 80 and over ; Cardiology - organization &amp; administration ; Congresses as Topic ; Female ; Heart Diseases - mortality ; Heart Diseases - therapy ; Hospitals, Teaching - statistics &amp; numerical data ; Humans ; Length of Stay ; Male ; Percutaneous Coronary Intervention - utilization ; United States - epidemiology</subject><ispartof>JAMA internal medicine, 2015-02, Vol.175 (2), p.237-244</ispartof><rights>Copyright 2014 American Medical Association. All rights reserved. 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a436t-4b0df9e6d51b0d9497a1ec3fe01ff3df4b0c882c9927ed6e552323df760b10593</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamainternalmedicine/articlepdf/10.1001/jamainternmed.2014.6781$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2014.6781$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,230,314,780,784,885,3331,27915,27916,76250,76253</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25531231$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jena, Anupam B</creatorcontrib><creatorcontrib>Prasad, Vinay</creatorcontrib><creatorcontrib>Goldman, Dana P</creatorcontrib><creatorcontrib>Romley, John</creatorcontrib><title>Mortality and Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions During Dates of National Cardiology Meetings</title><title>JAMA internal medicine</title><addtitle>JAMA Intern Med</addtitle><description>IMPORTANCE: Thousands of physicians attend scientific meetings annually. Although hospital physician staffing and composition may be affected by meetings, patient outcomes and treatment patterns during meeting dates are unknown. OBJECTIVE: To analyze mortality and treatment differences among patients admitted with acute cardiovascular conditions during dates of national cardiology meetings compared with nonmeeting dates. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of 30-day mortality among Medicare beneficiaries hospitalized with acute myocardial infarction (AMI), heart failure, or cardiac arrest from 2002 through 2011 during dates of 2 national cardiology meetings compared with identical nonmeeting days in the 3 weeks before and after conferences (AMI, 8570 hospitalizations during 82 meeting days and 57 471 during 492 nonmeeting days; heart failure, 19 282 during meeting days and 11 4591 during nonmeeting days; cardiac arrest, 1564 during meeting days and 9580 during nonmeeting days). Multivariable analyses were conducted separately for major teaching hospitals and nonteaching hospitals and for low- and high-risk patients. Differences in treatment utilization were assessed. EXPOSURES: Hospitalization during cardiology meeting dates. MAIN OUTCOMES AND MEASURES: Thirty-day mortality, procedure rates, charges, length of stay. RESULTS: Patient characteristics were similar between meeting and nonmeeting dates. In teaching hospitals, adjusted 30-day mortality was lower among high-risk patients with heart failure or cardiac arrest admitted during meeting vs nonmeeting dates (heart failure, 17.5% [95% CI, 13.7%-21.2%] vs 24.8% [95% CI, 22.9%-26.6%]; P &lt; .001; cardiac arrest, 59.1% [95% CI, 51.4%-66.8%] vs 69.4% [95% CI, 66.2%-72.6%]; P = .01). Adjusted mortality for high-risk AMI in teaching hospitals was similar between meeting and nonmeeting dates (39.2% [95% CI, 31.8%-46.6%] vs 38.5% [95% CI, 35.0%-42.0%]; P = .86), although adjusted percutaneous coronary intervention (PCI) rates were lower during meetings (20.8% vs 28.2%; P = .02). No mortality or utilization differences existed for low-risk patients in teaching hospitals or high- or low-risk patients in nonteaching hospitals. In sensitivity analyses, cardiac mortality was not affected by hospitalization during oncology, gastroenterology, and orthopedics meetings, nor was gastrointestinal hemorrhage or hip fracture mortality affected by hospitalization during cardiology meetings. CONCLUSIONS AND RELEVANCE: High-risk patients with heart failure and cardiac arrest hospitalized in teaching hospitals had lower 30-day mortality when admitted during dates of national cardiology meetings. High-risk patients with AMI admitted to teaching hospitals during meetings were less likely to receive PCI, without any mortality effect.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiology - organization &amp; administration</subject><subject>Congresses as Topic</subject><subject>Female</subject><subject>Heart Diseases - mortality</subject><subject>Heart Diseases - therapy</subject><subject>Hospitals, Teaching - statistics &amp; numerical data</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Percutaneous Coronary Intervention - utilization</subject><subject>United States - epidemiology</subject><issn>2168-6106</issn><issn>2168-6114</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUctuEzEUtRCIVqE_wAK8ZJPg5zw2SFFaKFIfLIpYWjfjO6mrmXGwPZXCR_DNeJSQtt74Ps45176HkI-cLThj_PMD9OCGhGHo0S4E42pRlBV_RU4FL6p5wbl6fYxZcULOYnxg-VSMKSnfkhOhteRC8lPy99qHBJ1LOwqDpXcBIfU4JPoD0jQh0mXvh82UulyO9NLHrZsYf9DSXy7d02UzJqQrCNb5R4jN2EGgKz9Yl5zPAudjcFnhHBJG6lt6A1MdugOl85sdvUZMGRTfkTctdBHPDveM_Px6cbe6nF_dfvu-Wl7NQckizdWa2bbGwmqeo1rVJXBsZIuMt620be43VSWauhYl2gK1FlLkelmwNWe6ljPyZa-7Hdd5iU3-WoDObIPrIeyMB2dedgZ3bzb-0SjJlZI6C3w6CAT_e8SYTO9ig10HA_oxGl5ooTTTed8zUu6hTfAxBmyPYzgzk6HmhaFmMtRMhmbmh-evPPL-25cB7_eALPDUZbKqy1r-A_OcrTo</recordid><startdate>20150201</startdate><enddate>20150201</enddate><creator>Jena, Anupam B</creator><creator>Prasad, Vinay</creator><creator>Goldman, Dana P</creator><creator>Romley, John</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20150201</creationdate><title>Mortality and Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions During Dates of National Cardiology Meetings</title><author>Jena, Anupam B ; Prasad, Vinay ; Goldman, Dana P ; Romley, John</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a436t-4b0df9e6d51b0d9497a1ec3fe01ff3df4b0c882c9927ed6e552323df760b10593</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiology - organization &amp; administration</topic><topic>Congresses as Topic</topic><topic>Female</topic><topic>Heart Diseases - mortality</topic><topic>Heart Diseases - therapy</topic><topic>Hospitals, Teaching - statistics &amp; numerical data</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Percutaneous Coronary Intervention - utilization</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jena, Anupam B</creatorcontrib><creatorcontrib>Prasad, Vinay</creatorcontrib><creatorcontrib>Goldman, Dana P</creatorcontrib><creatorcontrib>Romley, John</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA internal medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jena, Anupam B</au><au>Prasad, Vinay</au><au>Goldman, Dana P</au><au>Romley, John</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mortality and Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions During Dates of National Cardiology Meetings</atitle><jtitle>JAMA internal medicine</jtitle><addtitle>JAMA Intern Med</addtitle><date>2015-02-01</date><risdate>2015</risdate><volume>175</volume><issue>2</issue><spage>237</spage><epage>244</epage><pages>237-244</pages><issn>2168-6106</issn><eissn>2168-6114</eissn><abstract>IMPORTANCE: Thousands of physicians attend scientific meetings annually. Although hospital physician staffing and composition may be affected by meetings, patient outcomes and treatment patterns during meeting dates are unknown. OBJECTIVE: To analyze mortality and treatment differences among patients admitted with acute cardiovascular conditions during dates of national cardiology meetings compared with nonmeeting dates. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of 30-day mortality among Medicare beneficiaries hospitalized with acute myocardial infarction (AMI), heart failure, or cardiac arrest from 2002 through 2011 during dates of 2 national cardiology meetings compared with identical nonmeeting days in the 3 weeks before and after conferences (AMI, 8570 hospitalizations during 82 meeting days and 57 471 during 492 nonmeeting days; heart failure, 19 282 during meeting days and 11 4591 during nonmeeting days; cardiac arrest, 1564 during meeting days and 9580 during nonmeeting days). Multivariable analyses were conducted separately for major teaching hospitals and nonteaching hospitals and for low- and high-risk patients. Differences in treatment utilization were assessed. EXPOSURES: Hospitalization during cardiology meeting dates. MAIN OUTCOMES AND MEASURES: Thirty-day mortality, procedure rates, charges, length of stay. RESULTS: Patient characteristics were similar between meeting and nonmeeting dates. In teaching hospitals, adjusted 30-day mortality was lower among high-risk patients with heart failure or cardiac arrest admitted during meeting vs nonmeeting dates (heart failure, 17.5% [95% CI, 13.7%-21.2%] vs 24.8% [95% CI, 22.9%-26.6%]; P &lt; .001; cardiac arrest, 59.1% [95% CI, 51.4%-66.8%] vs 69.4% [95% CI, 66.2%-72.6%]; P = .01). Adjusted mortality for high-risk AMI in teaching hospitals was similar between meeting and nonmeeting dates (39.2% [95% CI, 31.8%-46.6%] vs 38.5% [95% CI, 35.0%-42.0%]; P = .86), although adjusted percutaneous coronary intervention (PCI) rates were lower during meetings (20.8% vs 28.2%; P = .02). No mortality or utilization differences existed for low-risk patients in teaching hospitals or high- or low-risk patients in nonteaching hospitals. In sensitivity analyses, cardiac mortality was not affected by hospitalization during oncology, gastroenterology, and orthopedics meetings, nor was gastrointestinal hemorrhage or hip fracture mortality affected by hospitalization during cardiology meetings. CONCLUSIONS AND RELEVANCE: High-risk patients with heart failure and cardiac arrest hospitalized in teaching hospitals had lower 30-day mortality when admitted during dates of national cardiology meetings. High-risk patients with AMI admitted to teaching hospitals during meetings were less likely to receive PCI, without any mortality effect.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>25531231</pmid><doi>10.1001/jamainternmed.2014.6781</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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subjects Aged
Aged, 80 and over
Cardiology - organization & administration
Congresses as Topic
Female
Heart Diseases - mortality
Heart Diseases - therapy
Hospitals, Teaching - statistics & numerical data
Humans
Length of Stay
Male
Percutaneous Coronary Intervention - utilization
United States - epidemiology
title Mortality and Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions During Dates of National Cardiology Meetings
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