ALL RIGHTS RESERVED EXAMINATION OF CARDIOVASCULAR OUTCOMES IN PATIENTS ADMITTED FOR ACUTE MYOCARDIAL INFARCTION WITHIN UNITED STATES COMMUNITY HOSPITALS EXAMINATION OF CARDIOVASCULAR OUTCOMES IN PATIENTS ADMITTED FOR ACUTE MYOCARDIAL INFARCTION WITHIN UNITED STATES COMMUNITY HOSPITALS

Kimberly Woodruff, Kimberly Woodruff, Kimberly Woodruff
unpublished
Objective: The objective of this dissertation was to examine cardiovascular (CV) outcomes in patients admitted for acute myocardial infarction (AMI) within United States (U.S.) community hospitals, focusing on three areas: impact of primary payer type among patients admitted for ST-segment elevation myocardial infarction (STEMI); effect of weekday vs. weekend admissions among STEMI hospitalizations; examination of trends in AMI type over a 10-year timeframe. Results: Chapter 1 results indicated
more » ... that among patients <65, those with private insurance as the primary payer type were significantly less likely to experience in-hospital mortality vs. patients with other primary forms of payment. In Chapter 2, results suggested that odds of in-hospital mortality in the overall cohort for weekday vs. weekend admissions depended on patient's race in 2005 and 2008, with no significant difference observed in 2010; however those with comorbid diabetes had more favorable outcomes when admitted on a weekday across all years studied. In Chapter 3, we observed an approximately 54% decrease in STEMI, and 10% decrease in NSTEMI hospitalizations over the timeframe studied; however the odds of in-hospital mortality remained significantly higher for STEMI vs. NSTEMI admissions over the decade. Conclusions: Results of this research suggest the following: 1) Patients <65 who have private health insurance experience lower odds of in-hospital mortality vs. those with other primary forms of payment; 2) In recent years, admission day does not appear to impact in-hospital mortality, except in those with comorbid diabetes; and 3) The clinical presentation of AMI within U.S. community hospitals has changed over the past decade; however STEMI admissions are still associated with increased odds of in-hospital mortality vs. NSTEMI admissions. iv ACKNOWLEDGEMENTS I would like to express my sincere thanks to my committee members, Drs. George
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