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

Kihei Yoneyama, Koshiro Kanaoka, Satoshi Okayama, Kunihiro Nishimura, Michikazu Nakai, Kunihiro Matsushita, Yoshihiro Miyamoto, Keisuke Kida, Yuki Ishibashi, Masaki Izumo, Makoto Watanabe, Tsunenari Soeda, Hiroyuki Okura, Tomoo Harada, Satoshi Yasuda, Toyoaki Murohara, Hisao Ogawa, Yoshihiko Saito, Yoshihiro J. Akashi

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

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.

Original languageEnglish
Article numbere024657
JournalBMJ open
Volume9
Issue number12
DOIs
Publication statusPublished - 2019 Dec 15
Externally publishedYes

Keywords

  • Heart failure
  • Internal medicine
  • Myocardial infarction

ASJC Scopus subject areas

  • Medicine(all)

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