No ‘July effect’ seen in management, outcomes of acute MI
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Data from more than 1.3 million admissions to teaching and nonteaching hospitals show there were no differences in clinical outcomes for acute MI in July, dispelling the notion of a “July effect” at teaching hospitals for this population.
“Acute MI is a very time-sensitive diagnosis and requires multidisciplinary input and prompt decision-making,” Saraschandra Vallabhajosyula, MD, MSc, FACP, FCCP, FCCM, FAHA, FACC, FSCAI, assistant professor of medicine and implementation science in the section of cardiovascular medicine at Wake Forest University School of Medicine, told Healio. “Due to the nature of teaching institutes, there is a cyclical influx of house staff every July. Prior work in acute MI and other disease states has shown a variation in care based on the time of year. We sought to evaluate this using the largest population of acute MI patients from the National Inpatient Sample (NIS).”
Vallabhajosyula and colleagues analyzed data from 1,312,006 adult hospitalizations for acute MI in May and July in urban teaching hospitals (54.2%) and urban nonteaching hospitals (45.8%) in the United States, identified from the Healthcare Cost and Utilization Project (HCUP)‐NIS database (2000-2017). Researchers compared in‐hospital mortality between May and July admissions and also conducted a difference‐in‐difference analysis comparing a change in outcome from May to July in teaching hospitals to a change in outcome from May to July in nonteaching hospitals.
The findings were published in Catheterization and Cardiovascular Interventions.
Researchers found that, compared with nonteaching hospitals, May admissions in teaching hospitals had greater comorbidity, higher rates of acute multiorgan failure (10.6% vs. 10.2%; P < .001) and lower rates of cardiac arrest compared with July admissions.
July admissions for acute MI had lower in‐hospital mortality compared with May admissions (5.6% vs. 5.8%) for an adjusted OR of 0.94 (95% CI, 0.92-0.97; P < .001) in teaching hospitals.
Using the difference‐in‐difference model, there was no evidence of a July effect for in‐hospital mortality (P = .19).
“We were not surprised as much as pleased that there were no differences in care at teaching institutes compared to nonteaching institutes,” Vallabhajosyula told Healio. “For a long time, there has been a hypothesis that patients receive better care at nonteaching institutes; however, more recent studies have dispelled that myth. With more protocoled care, higher rates of involvement of attending physicians, work hour restrictions of house staff and the overall advancements in cardiovascular care, it is as safe to be admitted to a teaching institute as compared with nonteaching institutes.”
Vallabhajosyula said continued monitoring of clinical care protocols, education research and continued support of trainees as they progress are crucial next steps to consolidate positive results.
For more information:
Saraschandra Vallabhajosyula, MD, MSc, FACP, FCCP, FCCM, FAHA, FACC, FSCAI, can be reached at svallabh@wakehealth.edu; Twitter: @sarasvallabhmd.
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