Dataset Information

Identification of Hospital Cardiac Services for Acute Myocardial Infarction Using Individual Patient Discharge Data.

ABSTRACT:

Background

The availability of hospital cardiac services may vary between hospitals and influence care processes and outcomes. However, data on available cardiac services are restricted to a limited number of services collected by the American Hospital Association (AHA) annual survey. We developed an alternative method to identify hospital services using individual patient discharge data for acute myocardial infarction (AMI) in the Premier Healthcare Database.

Methods and results

Thirty-five inpatient cardiac services relevant for AMI care were identified using American Heart Association/American College of Cardiology guidelines. Thirty-one of these services could be defined using patient-level administrative data codes, such as International Classification of Diseases, Ninth Revision, Clinical Modification and Current Procedural Terminology codes. A hospital was classified as providing a service if it had ?5 instances for the service in the Premier database from 2009 to 2011. Using this system, the availability of these services among 432 Premier hospitals ranged from 100% (services such as chest X-ray) to 1.2% (heart transplant service). To measure the accuracy of this method using administrative data, we calculated agreement between the AHA survey and Premier for a subset of 16 services defined by both sources. There was a high percentage of agreement (?80%) for 11 of 16 (68.8%) services, moderate agreement for 3 of 16 (18.8%) services, and low agreement (?50%) for 2 of 16 services (12.5%).

Conclusions

The availability of cardiac services for AMI care varies widely among hospitals. Using individual patient discharge data is a feasible method to identify these cardiac services, particularly for those services pertaining to inpatient care.

SUBMITTER: Chang TE

PROVIDER: S-EPMC5079029 | biostudies-literature | 2016 Sep

REPOSITORIES: biostudies-literature

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Publications

Identification of Hospital Cardiac Services for Acute Myocardial Infarction Using Individual Patient Discharge Data.

Chang Tiffany E TE Krumholz Harlan M HM Li Shu-Xia SX Martin John J Ranasinghe Isuru I

Journal of the American Heart Association 20160914 9

<h4>Background</h4>The availability of hospital cardiac services may vary between hospitals and influence care processes and outcomes. However, data on available cardiac services are restricted to a limited number of services collected by the American Hospital Association (AHA) annual survey. We developed an alternative method to identify hospital services using individual patient discharge data for acute myocardial infarction (AMI) in the Premier Healthcare Database.<h4>Methods and results</h4> ...[more]

PMID: 27628573

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Project description:Objective To characterise the determinants, time course, and risks of acute myocardial infarction associated with use of oral non-steroidal anti-inflammatory drugs (NSAIDs).Design Systematic review followed by a one stage bayesian individual patient data meta-analysis.Data sources Studies from Canadian and European healthcare databases.Review methods Eligible studies were sourced from computerised drug prescription or medical databases, conducted in the general or an elderly population, documented acute myocardial infarction as specific outcome, studied selective cyclo-oxygenase-2 inhibitors (including rofecoxib) and traditional NSAIDs, compared risk of acute myocardial infarction in NSAID users with non-users, allowed for time dependent analyses, and minimised effects of confounding and misclassification bias. Exposure and outcomes Drug exposure was modelled as an indicator variable incorporating the specific NSAID, its recency, duration of use, and dose. The outcome measures were the summary adjusted odds ratios of first acute myocardial infarction after study entry for each category of NSAID use at index date (date of acute myocardial infarction for cases, matched date for controls) versus non-use in the preceding year and the posterior probability of acute myocardial infarction.Results A cohort of 446 763 individuals including 61 460 with acute myocardial infarction was acquired. Taking any dose of NSAIDs for one week, one month, or more than a month was associated with an increased risk of myocardial infarction. With use for one to seven days the probability of increased myocardial infarction risk (posterior probability of odds ratio >1.0) was 92% for celecoxib, 97% for ibuprofen, and 99% for diclofenac, naproxen, and rofecoxib. The corresponding odds ratios (95% credible intervals) were 1.24 (0.91 to 1.82) for celecoxib, 1.48 (1.00 to 2.26) for ibuprofen, 1.50 (1.06 to 2.04) for diclofenac, 1.53 (1.07 to 2.33) for naproxen, and 1.58 (1.07 to 2.17) for rofecoxib. Greater risk of myocardial infarction was documented for higher dose of NSAIDs. With use for longer than one month, risks did not appear to exceed those associated with shorter durations.Conclusions All NSAIDs, including naproxen, were found to be associated with an increased risk of acute myocardial infarction. Risk of myocardial infarction with celecoxib was comparable to that of traditional NSAIDS and was lower than for rofecoxib. Risk was greatest during the first month of NSAID use and with higher doses.

Dataset Information

Identification of Hospital Cardiac Services for Acute Myocardial Infarction Using Individual Patient Discharge Data.

Background

Methods and results

Conclusions

Publications

Identification of Hospital Cardiac Services for Acute Myocardial Infarction Using Individual Patient Discharge Data.

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