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Number of Cardiologists per Cardiovascular Beds and In-Hospital Mortality for Acute Heart Failure: A Nationwide Study in Japan.

ABSTRACT: Background Little evidence is available about the number of cardiologists required for appropriate treatment of heart failure (HF). Our objective was to determine the association between the number of cardiologists per cardiology beds for treating patients with acute HF and in-hospital mortality. Methods and Results This was a cross-sectional study, and we used the Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination discharge database. The data of patients with HF on emergency admission from April 1, 2012, to March 31, 2014, were extracted. The patients were categorized into 4 groups by the quartiles of the numbers of cardiologists per 50 cardiovascular beds (first group: median, 4.4 [interquartile range, 3.5-5.0]; second group: median, 6.7 [interquartile range, 6.5-7.5]; third group: median, 9.7 [interquartile range, 8.8-10.1]; and fourth group: median, 16.7 [interquartile range, 14.0-23.8]). Using multilevel mixed-effect logistics regression, we determined adjusted odds ratios for in-hospital mortality. We identified 154 290 patients with HF on emergency admissions. There were 29 626, 36 587, 46 451, and 41 626 patients in the first, second, third, and fourth groups, respectively. HF severity, on the basis of New York Heart Association classification, was similar in the 3 groups. Adjusted odds ratios (95% CIs) for in-hospital mortality were 0.92 (0.82-1.04; P=0.20), 0.82 (0.72-0.92; P<0.001), and 0.70 (0.61-0.80; P<0.001) for the second, third, and fourth groups, respectively. The proportion of medication used, including angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, ? blockers, and mineralocorticoid receptor antagonists, was positively correlated to the number of cardiologists. Conclusions Patients hospitalized for HF in hospitals with larger numbers of cardiologists per cardiovascular beds had lower 30-day mortality.

SUBMITTER: Kanaoka K

PROVIDER: S-EPMC6818015 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Number of Cardiologists per Cardiovascular Beds and In-Hospital Mortality for Acute Heart Failure: A Nationwide Study in Japan.

Kanaoka Koshiro K Okayama Satoshi S Nakai Michikazu M Sumita Yoko Y Onoue Kenji K Soeda Tsunenari T Nishimura Kunihiro K Kawakami Rika R Okura Hiroyuki H Miyamoto Yoshihiro Y Yasuda Satoshi S Tsutsui Hiroyuki H Komuro Issei I Ogawa Hisao H Saito Yoshihiko Y

Journal of the American Heart Association 20190909 18

Background Little evidence is available about the number of cardiologists required for appropriate treatment of heart failure (HF). Our objective was to determine the association between the number of cardiologists per cardiology beds for treating patients with acute HF and in-hospital mortality. Methods and Results This was a cross-sectional study, and we used the Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination discharge database. The data of patients with ...[more]

PMID: 31495302

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Project description:ObjectivesAlthough there are 14?097 board-certified cardiologists in Japan, it is unknown whether the number of institutional board-certified cardiologists is related to the prognosis of cardiovascular disease patients.DesignCross-sectional analysis.SettingData were collected from the nationwide database of acute care hospitals in Japan (2371 hospitals) between 2012 and 2013.ParticipantsA total of 1?422?703 consecutive patients were initially included in this study, but 518?610 patients were excluded due to age <18 years, missing data or prior hospitalisations; therefore, 896?171 patients comprised the final sample population.Main outcome measuresThe primary outcome was in-hospital mortality due to any cause. For the per-hospital analysis, Poisson regression models were used to estimate the association of board-certified cardiologists with in-hospital mortality, adjusted for hospital facilitation. For the per-patient analysis, hierarchical logistic regression models were used to estimate the ORs of the number of institutional board-certified cardiologists, adjusted for patient demographics, diagnoses, therapies and hospital facilities.ResultsThe regression model of the per-hospital analysis indicated that the number of board-certified cardiologists was associated with a lower rate ratio of in-hospital mortality (rate ratio, 0.988; 95% CI 0.983 to 0.993; p<0.01). The per-patient analysis indicated that the median age was 73 years and the in-hospital mortality rate was 11.7%. The regression model indicated that the presence of more board-certified cardiologists was associated with a lower risk of in-hospital mortality (OR, 0.980; 95%?CI 0.975 to 0.986; p<0.01) after adjustments for hospital facilities, patient characteristics and treatments.ConclusionsAmong cardiovascular disease patients admitted to acute care hospitals in Japan, the presence of more board-certified cardiologists was associated with a lower risk of in-hospital mortality. These results have implications for national and institutional strategies for determining the required number of board-certified cardiologists.

Dataset Information

Number of Cardiologists per Cardiovascular Beds and In-Hospital Mortality for Acute Heart Failure: A Nationwide Study in Japan.

Publications

Number of Cardiologists per Cardiovascular Beds and In-Hospital Mortality for Acute Heart Failure: A Nationwide Study in Japan.

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