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Mortality associated with gastrointestinal bleeding events: Comparing short-term clinical outcomes of patients hospitalized for upper GI bleeding and acute myocardial infarction in a US managed care setting.

Wilcox CM, Cryer BL, Henk HJ, Zarotsky V, Zlateva G - Clin Exp Gastroenterol (2009)

Bottom Line: Propensity score matching yielded 6,923 matched pairs.Matched cohorts were found to have a similar Charlson Comorbidity Index score and to be similar on nearly all utilization and cost measures (excepting emergency room costs).GI bleeding events result in significant mortality similar to that of an AMI after adjusting for the initial hospitalization.

View Article: PubMed Central - PubMed

Affiliation: University of Alabama, Birmingham, AL, USA;

ABSTRACT

Objectives: To compare the short-term mortality rates of gastrointestinal (GI) bleeding to those of acute myocardial infarction (AMI) by estimating the 30-, 60-, and 90-day mortality among hospitalized patients.

Methods: United States national health plan claims data (1999-2003) were used to identify patients hospitalized with a GI bleeding event. Patients were propensity-matched to AMI patients with no evidence of GI bleed from the same US health plan.

Results: 12,437 upper GI-bleed patients and 22,847 AMI patients were identified. Propensity score matching yielded 6,923 matched pairs. Matched cohorts were found to have a similar Charlson Comorbidity Index score and to be similar on nearly all utilization and cost measures (excepting emergency room costs). A comparison of outcomes among the matched cohorts found that AMI patients had higher rates of 30-day mortality (4.35% vs 2.54%; p < 0.0001) and rehospitalization (2.56% vs 1.79%; p = 0.002), while GI bleed patients were more likely to have a repeat procedure (72.38% vs 44.95%; p < 0.001) following their initial hospitalization. The majority of the difference in overall 30-day mortality between GI bleed and AMI patients was accounted for by mortality during the initial hospitalization (1.91% vs 3.58%).

Conclusions: GI bleeding events result in significant mortality similar to that of an AMI after adjusting for the initial hospitalization.

No MeSH data available.


Related in: MedlinePlus

Pre-matched mortality for gastrointestinal (GI) bleed and acute myocardial infarction (AMI) during and following initial hospitalization.
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f1-ceg-2-021: Pre-matched mortality for gastrointestinal (GI) bleed and acute myocardial infarction (AMI) during and following initial hospitalization.

Mentions: A total of 12,437 patients met the study criteria for inclusion into the GI bleed sample and 22,847 for inclusion into the AMI sample. Prior to matching, patients in the GI bleed and AMI samples differed significantly with regard to patient characteristics, medication use, CCI score, and health care utilization and costs, as shown in Tables 2 and 3. Patients in the AMI sample were generally older, and a significantly higher proportion of the AMI cohort was male. A comparison of baseline medication use revealed several significant differences between the cohorts. Patients in the AMI sample were significantly more likely to have taken most cardiovascular medications, including ACE inhibitors, ARBs, beta-blockers, alpha-blockers, CCBs, nitrates, and lipid-lowering agents. By contrast, patients in the GI bleed sample had higher use of both GI medications (ie, proton pump inhibitors, H2 antagonists, and sucralfate) and medications known to increase risk for GI bleeding (ie, anticoagulants, corticosteroids, bisphosphonates, COX-2 inhibitors, and other NSAIDs). The GI bleed sample also had a higher mean CCI score than the AMI sample. Similarly, a comparison of baseline utilization and costs by patients in each sample found that the GI bleed sample had significantly higher values on nearly every measure. Figure 1 reports prematch mortality outcomes.


Mortality associated with gastrointestinal bleeding events: Comparing short-term clinical outcomes of patients hospitalized for upper GI bleeding and acute myocardial infarction in a US managed care setting.

Wilcox CM, Cryer BL, Henk HJ, Zarotsky V, Zlateva G - Clin Exp Gastroenterol (2009)

Pre-matched mortality for gastrointestinal (GI) bleed and acute myocardial infarction (AMI) during and following initial hospitalization.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3108636&req=5

f1-ceg-2-021: Pre-matched mortality for gastrointestinal (GI) bleed and acute myocardial infarction (AMI) during and following initial hospitalization.
Mentions: A total of 12,437 patients met the study criteria for inclusion into the GI bleed sample and 22,847 for inclusion into the AMI sample. Prior to matching, patients in the GI bleed and AMI samples differed significantly with regard to patient characteristics, medication use, CCI score, and health care utilization and costs, as shown in Tables 2 and 3. Patients in the AMI sample were generally older, and a significantly higher proportion of the AMI cohort was male. A comparison of baseline medication use revealed several significant differences between the cohorts. Patients in the AMI sample were significantly more likely to have taken most cardiovascular medications, including ACE inhibitors, ARBs, beta-blockers, alpha-blockers, CCBs, nitrates, and lipid-lowering agents. By contrast, patients in the GI bleed sample had higher use of both GI medications (ie, proton pump inhibitors, H2 antagonists, and sucralfate) and medications known to increase risk for GI bleeding (ie, anticoagulants, corticosteroids, bisphosphonates, COX-2 inhibitors, and other NSAIDs). The GI bleed sample also had a higher mean CCI score than the AMI sample. Similarly, a comparison of baseline utilization and costs by patients in each sample found that the GI bleed sample had significantly higher values on nearly every measure. Figure 1 reports prematch mortality outcomes.

Bottom Line: Propensity score matching yielded 6,923 matched pairs.Matched cohorts were found to have a similar Charlson Comorbidity Index score and to be similar on nearly all utilization and cost measures (excepting emergency room costs).GI bleeding events result in significant mortality similar to that of an AMI after adjusting for the initial hospitalization.

View Article: PubMed Central - PubMed

Affiliation: University of Alabama, Birmingham, AL, USA;

ABSTRACT

Objectives: To compare the short-term mortality rates of gastrointestinal (GI) bleeding to those of acute myocardial infarction (AMI) by estimating the 30-, 60-, and 90-day mortality among hospitalized patients.

Methods: United States national health plan claims data (1999-2003) were used to identify patients hospitalized with a GI bleeding event. Patients were propensity-matched to AMI patients with no evidence of GI bleed from the same US health plan.

Results: 12,437 upper GI-bleed patients and 22,847 AMI patients were identified. Propensity score matching yielded 6,923 matched pairs. Matched cohorts were found to have a similar Charlson Comorbidity Index score and to be similar on nearly all utilization and cost measures (excepting emergency room costs). A comparison of outcomes among the matched cohorts found that AMI patients had higher rates of 30-day mortality (4.35% vs 2.54%; p < 0.0001) and rehospitalization (2.56% vs 1.79%; p = 0.002), while GI bleed patients were more likely to have a repeat procedure (72.38% vs 44.95%; p < 0.001) following their initial hospitalization. The majority of the difference in overall 30-day mortality between GI bleed and AMI patients was accounted for by mortality during the initial hospitalization (1.91% vs 3.58%).

Conclusions: GI bleeding events result in significant mortality similar to that of an AMI after adjusting for the initial hospitalization.

No MeSH data available.


Related in: MedlinePlus