Author + information
- Received April 3, 2017
- Revision received May 15, 2017
- Accepted May 18, 2017
- Published online August 7, 2017.
- Tushar Acharya, MDa,
- Adam C. Salisbury, MD, MScb,c,
- John A. Spertus, MD, MPHb,c,
- Kevin F. Kennedy, MSb,c,
- Amarbir Bhullar, MDa,
- H. Kiran K. Reddy, MDa,
- Bipin K. Joshi, MDa and
- John A. Ambrose, MDa,∗ ()
- aUniversity of California, San Francisco, Fresno, California
- bSaint Luke’s Mid-America Heart Institute, Kansas City, Missouri
- cUniversity of Missouri-Kansas City, Kansas City, Missouri
- ↵∗Address for correspondence:
Dr. John A. Ambrose, UCSF Fresno, Division of Cardiology Academic Offices, 2335 East Kashian Lane, Suite 460, Fresno, California 93721.
Objectives This study compared risk-adjusted percutaneous coronary intervention (PCI) outcomes of safety-net hospitals (SNHs) and non-SNHs.
Background Although risk adjustment is used to compare hospitals, SNHs treat a disproportionate share of uninsured and underinsured patients, who may have unmeasured risk factors, limited health care access, and poorer outcomes than patients treated at non-SNHs.
Methods Using the National Cardiovascular Data Registry CathPCI Registry from 2009 to 2015, we analyzed 3,746,961 patients who underwent PCI at 282 SNHs (hospitals where ≥10% of PCI patients were uninsured) and 1,134 non-SNHs. The relationship between SNH status and risk-adjusted outcomes was assessed.
Results SNHs were more likely to be lower volume, rural hospitals located in the southern states. Patients treated at SNHs were younger (63 vs. 65 years), more often nonwhite (17% vs. 12%), smokers (33% vs. 26%), and more likely to be admitted through the emergency department (48% vs. 38%) and to have an ST-segment elevation myocardial infarction (20% vs. 14%) than non-SNHs (all p < 0.001). Patients undergoing PCI at SNHs had higher risk-adjusted in-hospital mortality (odds ratio: 1.23; 95% confidence interval: 1.17 to 1.32; p < 0.001), although the absolute risk difference between groups was small (0.4%). Risk-adjusted bleeding (odds ratio: 1.05; 95% confidence interval: 1.00 to 1.12; p = 0.062) and acute kidney injury rates (odds ratio: 1.01; 95% confidence interval: 0.96 to 1.07; p = 0.51) were similar.
Conclusions Despite treating a higher proportion of uninsured patients with more acute presentations, risk-adjusted PCI-related in-hospital mortality of SNHs is only marginally higher (4 additional deaths per 1,000 PCI cases) than non-SNHs, whereas risk-adjusted bleeding and acute kidney injury rates are comparable.
Dr. Salisbury has received research grant support from Boston Scientific; and speaking fees/honoraria from Abiomed. Dr. Spertus has an analytic contract from the American College of Cardiology Foundation to analyze the National Cardiovascular Data Registry. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 3, 2017.
- Revision received May 15, 2017.
- Accepted May 18, 2017.
- 2017 American College of Cardiology Foundation
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