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Association between the number of board-certified cardiologists and the risk of in-hospital mortality: a nationwide study involving the Japanese registry of all cardiac and vascular diseases

OBJECTIVES: Although there are 14 097 board-certified cardiologists in Japan, it is unknown whether the number of institutional board-certified cardiologists is related to the prognosis of cardiovascular disease patients. DESIGN: Cross-sectional analysis. SETTING: Data were collected from the nation...

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Detalles Bibliográficos
Autores principales: Yoneyama, Kihei, Kanaoka, Koshiro, Okayama, Satoshi, Nishimura, Kunihiro, Nakai, Michikazu, Matsushita, Kunihiro, Miyamoto, Yoshihiro, Kida, Keisuke, Ishibashi, Yuki, Izumo, Masaki, Watanabe, Makoto, Soeda, Tsunenari, Okura, Hiroyuki, Harada, Tomoo, Yasuda, Satoshi, Murohara, Toyoaki, Ogawa, Hisao, Saito, Yoshihiko, Akashi, Yoshihiro J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6924792/
https://www.ncbi.nlm.nih.gov/pubmed/31843816
http://dx.doi.org/10.1136/bmjopen-2018-024657
Descripción
Sumario:OBJECTIVES: Although there are 14 097 board-certified cardiologists in Japan, it is unknown whether the number of institutional board-certified cardiologists is related to the prognosis of cardiovascular disease patients. DESIGN: Cross-sectional analysis. SETTING: Data were collected from the nationwide database of acute care hospitals in Japan (2371 hospitals) between 2012 and 2013. PARTICIPANTS: A total of 1 422 703 consecutive patients were initially included in this study, but 518 610 patients were excluded due to age <18 years, missing data or prior hospitalisations; therefore, 896 171 patients comprised the final sample population. MAIN OUTCOME MEASURES: The primary outcome was in-hospital mortality due to any cause. For the per-hospital analysis, Poisson regression models were used to estimate the association of board-certified cardiologists with in-hospital mortality, adjusted for hospital facilitation. For the per-patient analysis, hierarchical logistic regression models were used to estimate the ORs of the number of institutional board-certified cardiologists, adjusted for patient demographics, diagnoses, therapies and hospital facilities. RESULTS: The regression model of the per-hospital analysis indicated that the number of board-certified cardiologists was associated with a lower rate ratio of in-hospital mortality (rate ratio, 0.988; 95% CI 0.983 to 0.993; p<0.01). The per-patient analysis indicated that the median age was 73 years and the in-hospital mortality rate was 11.7%. The regression model indicated that the presence of more board-certified cardiologists was associated with a lower risk of in-hospital mortality (OR, 0.980; 95% CI 0.975 to 0.986; p<0.01) after adjustments for hospital facilities, patient characteristics and treatments. CONCLUSIONS: Among cardiovascular disease patients admitted to acute care hospitals in Japan, the presence of more board-certified cardiologists was associated with a lower risk of in-hospital mortality. These results have implications for national and institutional strategies for determining the required number of board-certified cardiologists.