Abstract 18756: Impact of Hospital Teaching Status on In-Patient Outcomes of Acute Myocardial Infarction

Introduction: Prior studies have shown better outcomes for acute myocardial infarction (AMI) patients admitted to teaching compared to non-teaching hospitals. Similar trend was seen in studies limited to ST elevation myocardial infarction (STEMI) patients. We examined the impact of hospital teaching status on in-patient outcomes in AMI patients usingcurrent data and International Classification of Diseases 10 ^th Revision (ICD-10) system.

Hypothesis: Acute myocardial infarction patients treated in teaching hospitals have better outcomes compared to patients treated in non teaching hospitals.

Methods: We queried the 2016 and 2017 NIS databases to identify all patients over 18 years of age hospitalized for AMI. With hospital teaching status as an independent variable, multivariate logistic regression was used to compare mortality rates in AMI patients (primary outcome) and likelihood of revascularization within 24 hours for NSTEMI (secondary outcome); linear regression was used to compare length of stay(LOS) for NSTEMI patients (secondary outcome).

Results: Of 1,308,314 patients with AMI (351,970 with STEMI and 955,314 with NSTEMI), 66.5% were admitted to teaching hospitals. In-patient mortality rate was higher in teaching (4.8%) compared to non-teaching (4.5%) hospitals [adjusted odds ratio (aOR) 1.16, 95% CI 1.12 to 1.21, p < 0.001]. This was true for both STEMI [aOR 1.1, 95% CI 1.03 to 1.17, p = 0.004] and NSTEMI [aOR 1.16, 95% CI 1.10 to 1.22, p < 0.001] patients. NSTEMI admitted to teaching hospitals were more likely to be revascularized within 24 hours of admission [aOR 1.27, 95% CI 1.22 to 1.33, p < 0.001] compared to non-teaching hospitals. LOS for NSTEMI patients admitted to teaching hospitals was longer compared to non-teaching hospitals [4.9 vs 3.9 days, p < 0.001].

Conclusions: Patients with AMI admitted to teaching hospitals had higher mortality rates compared to non-teaching hospitals. This contradicts the results of prior studies. Further research is warranted in this regard. NSTEMI patients admitted to teaching hospitals were more likely to be revascularized within 24 hours compared to non-teaching hospitals, but this did not translate to better mortality outcome. LOS was longer for NSTEMI patients admitted to teaching hospitals.