Utilization of Palliative Care for Cardiogenic Shock Complicating Acute Myocardial Infarction: A 15-Year National Perspective on Trends, Disparities, Predictors, and Outcomes
Utilization of Palliative Care for Cardiogenic Shock Complicating Acute Myocardial Infarction: A 15-Year National Perspective on Trends, Disparities, Predictors, and Outcomes
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DOI：
10.1161/jaha.119.011954
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发表时间：
2019-08-06
影响因子：
5.4
通讯作者：
Barsness, Gregory W.
中科院分区：
文献类型：
--
作者：
Vallabhajosyula, Saraschandra;Prasad, Abhiram;Barsness, Gregory W.
背景-这项研究试图评估15年来全国姑息治疗服务(PCS)在急性心肌梗死合并心源性休克中的使用情况、趋势、预测因素、差异和结果。方法和结果-使用国家住院患者样本数据库对2000年1月1日至2014年12月31日的回顾队列进行分析。急性心肌梗死-心源性休克的管理代码和PCS用于确定符合条件的入院患者。主要结果是PCS的使用频率、使用趋势和预测因素。次要结果包括住院死亡率和资源利用。使用多变量回归和倾向匹配分析来控制混杂。在这15年期间，有444253例急性心肌梗死心源性休克入院，其中4.5%接受了PCS。接受PCS治疗的队列年龄较大，白人，女性，有较高的合并症和急性器官衰竭。PCS队列接受的心脏手术较少，但接受了更多的非心脏器官支持治疗。高龄、女性、白人、较高的合并症、较高的社会经济地位、入住较大的医院以及2008年后入院是PCS使用的独立预测因素。使用PCS独立地与较高的住院死亡率相关(优势比6.59[95%可信区间6.37-6.83]；P2倍的住院死亡率，12倍于非复苏状态的使用，较少的医院资源利用和较少的出院)。在倾向匹配的队列中也观察到了类似的发现。结论：在急性心肌梗死患者中，心源性休克患者使用PCS的比例很低，尽管有增加采用的趋势。在使用PCS方面，患者和医院之间存在着显著的差异。
Background-This study sought to evaluate the 15-year national utilization, trends, predictors, disparities, and outcomes of palliative care services (PCS) use in cardiogenic shock complicating acute myocardial infarction.Methods and Results-A retrospective cohort from January 1, 2000 through December 31, 2014 was analyzed using the National Inpatient Sample database. Administrative codes for acute myocardial infarction-cardiogenic shock and PCS were used to identify eligible admissions. The primary outcomes were the frequency, utilization trends, and predictors of PCS. Secondary outcomes included in-hospital mortality and resources utilization. Multivariable regression and propensity-matching analyses were used to control for confounding. In this 15-year period, there were 444 253 acute myocardial infarction-cardiogenic shock admissions, of which 4.5% received PCS. The cohort receiving PCS was older, of white race, female sex, and with higher comorbidity and acute organ failure. The PCS cohort received fewer cardiac procedures, but more noncardiac organ support therapies. Older age, female sex, white race, higher comorbidity, higher socioeconomic status, admission to a larger hospital, and admission after 2008 were independent predictors of PCS use. Use of PCS was independently associated with higher in-hospital mortality (odds ratio 6.59 [95% CI 6.37-6.83]; P2-fold higher in-hospital mortality, 12-fold higher use of do-not-resuscitate status, lesser in-hospital resource utilization, and fewer discharges to home. Similar findings were observed in the propensity-matched cohort.Conclusions-PCS use in patients with acute myocardial infarction-cardiogenic shock is low, though there is a trend towards increased adoption. There are significant patient and hospital-specific disparities in the utilization of PCS.