This article is more than 5 years old. Information may no longer be current.
In-hospital bleeding rates among non-STEMI patients vary widely
Click Here to Manage Email Alerts
A new study identified considerable variation across US hospitals in the rate of major bleeding events among patients with non-STEMI.
“Although patient factors and treatments explained less than one-third of hospital-level variation, [approximately] 70% of bleeding variation remains after adjustment,” researchers wrote.
For the retrospective study, researchers evaluated 99,200 patients with non-STEMI. The patients were cared for at 267 hospitals and were enrolled in the National Cardiovascular Data Registry (NCDR) Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With the Guidelines between January 2007 and June 2010.
The researchers’ goal was to delineate rates and sources of in-hospital major bleeding, which was defined as an absolute drop in hemoglobin ≥4 g/dL; intracranial hemorrhage; documented or suspected retroperitoneal bleed; any transfusion of red blood cells with baseline hemoglobin ≥9 g/dL; or any red blood cell transfusion with hemoglobin <9 g/dL and suspected bleeding. Bleeding events were evaluated in the current study only if they occurred before CABG.
According to the results, 9.6% of patients experienced an in-hospital bleeding event. The median of the projected distribution of major bleeding events across hospitals was 9.4% (interquartile range, 7.5% to 11.7%). Bleeding rates at some hospitals were more than 2.3 times higher than at other hospitals (10th-90th percentile, 6.1% to 14.2%), according to the abstract.
Differences in case mix accounted for 19.2% of the variation in bleeding across hospitals, anticoagulation strategies accounted for 9.9% of the variation and antiplatelet strategies accounted for 6.8% of the variation. Altogether, the researchers found that 32.3% of the variation in bleeding across hospitals stemmed from differences in patient case mix and treatment approaches.
“A better understanding of etiologies of hospital variation in bleeding complications may help institutions target high-risk patients and provide optimal care in this population,” the researchers wrote.
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.
Click Here to Manage Email Alerts