부산대학교 도서관

Background:Palliative care and hospice programs have been shown to improve patient-centered outcomes for multiple chronic medical conditions. Little research, however, has been done to investigate patient- and hospital-level patterns and predictors of comfort measures only (CMO) care among patients with acute myocardial infarction (AMI).Methods:We examined trends in the proportion of patients with AMI who were discharged on CMO between January 2015 and June 2018 in the NCDR Chest Pain-MI Registry. A multivariable logistic regression model identified factors associated with CMO care, with a median odds ratio (OR) describing hospital effect compared with patient factors.Results:Among 483,218 patients with AMI (median age 64) across 794 hospitals, 13,955 (2.9%) died or were discharged with CMO status (2.3% within NSTEMI and 3.4% within STEMI populations, respectively). There was no significant change in rate over time. AMI patients with higher frailty scores, higher ACTION mortality and bleeding scores, as well as white, male, and non-private insurance carrying patients were more likely to be CMO (Figure). The hospital at which the patient was treated was significantly associated with higher likelihood of being CMO (median OR = 1.59; 95% CI: 1.56-1.62), with the proportion of CMO patients ranging from 0% to 17.1% across hospitals.Conclusions:Palliative care remains infrequent among AMI patients with significant inter-hospital variation use. Appropriately transitioning patients to CMO and aligning care with patients? values and preferences remain important areas for future quality programs for AMI.