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

Study Questions:

What is the effect of cardiology-based scientific meetings on patient outcomes and treatment patterns for three acute cardiovascular conditions: acute myocardial infarction (AMI), heart failure, and cardiac arrest?

Methods:

This was a retrospective analysis of 30-day mortality among Medicare beneficiaries hospitalized from 2002 through 2011, during dates of the American College of Cardiology and American Heart Association national meetings. Patient outcomes and treatment patterns in this group were compared with identical nonmeeting days in the 3 weeks before and after conferences. Multivariable analyses were conducted separately for major teaching hospitals and nonteaching hospitals, and for low- and high-risk patients, and numerous sensitivity analyses were performed examining the results during noncardiology-based meetings and in patients with noncardiovascular conditions. Differences in treatment patterns also were assessed.

Results:

The authors reported: “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 versus nonmeeting dates (heart failure, 17.5% [95% confidence interval (CI), 13.7%-21.2%] vs. 24.8% [95% CI, 22.9%-26.6%]; p < 0.001; cardiac arrest, 59.1% [95% CI, 51.4%-66.8%] vs. 69.4% [95% CI, 66.2%-72.6%]; p = 0.01). 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 = 0.86), although adjusted percutaneous coronary intervention (PCI) rates were lower during meetings (20.8% vs. 28.2%; p = 0.02). 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:

The authors concluded that key groups (e.g., high-risk patients with heart failure and cardiac arrest) hospitalized in teaching hospitals had lower 30-day mortality when admitted during dates of national meetings. For high-risk patients with AMI admitted to teaching hospitals during meetings, the authors found PCI was less commonly utilized, with no effect on mortality.

Perspective:

This is a fascinating study of a previously unexamined area. The analysis is very sophisticated, and I really found their creative use of ‘falsification hypotheses’ (e.g., examining their results during oncology meetings or examining results for hip fracture) fairly convincing. The authors acknowledge that it is difficult to put this finding together with what they or others might commonly expect; namely, diminished staffing and changes in composition of physicians during these meetings would lead to shortages and worse outcomes. Indeed, rather than viewing this through the lens of worse outcomes for patients after-hours or on weekends, they invoke a long literature on improved outcomes during times of health care worker strikes (Cunningham SA. Soc Sci Med 2008;67:1784-8). This study will generate a lot of interest and be talked about quite a bit around the water coolers.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, SCD/Ventricular Arrhythmias, Acute Heart Failure

Keywords: American Heart Association, Heart Arrest, Heart Failure, Hospitalization, Hospitals, Teaching, Medicare, Myocardial Infarction, Percutaneous Coronary Intervention


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