Circulation journal : official journal of the Japanese Circulation Society · 2026
Association Between Initial Admission Ward and In-Hospital Mortality Among Patients Hospitalized for Cardiovascular Emergencies - A Nationwide Study Using the JROAD-DPC Database.
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Kuwabara Masanari, Yamamoto Takeshi, Tahara Yoshio, Kikuchi Migaku, Imamura Hiroshi, Takeuchi Ichiro, Sato Naoki, Itoh Tomonori, Sumita Yoko, Miyamoto Yoshihiro, Ishihara Shiro, Isoda Kikuo, Ishizu Tomoko, Ikari Yuji, Tanimoto Shuzou, Matsuo Yae, Murai Ryosuke, Ikeda Takanori, Okura Hiroyuki, Kobayashi Yoshio, Asai Kuniya, Japanese Circulation Society Emergency and Critical Care Committee
Аннотация
BACKGROUND: Although intensive care is considered important for cardiovascular emergencies, large-scale evidence comparing outcomes by initial admission ward remains limited in Japan.
METHODS AND RESULTS: Using the JROAD database, we identified patients hospitalized for cardiovascular emergencies after ambulance transport between April 2016 and March 2024 and classified patients by initial ward (intensive care unit [ICU], high care unit [HCU], or general ward [GW]). Deaths within 24 h were excluded. Multivariable logistic regression analysis was performed with adjustment for demographics, comorbidities, acute therapies, and hospital cardiologist staffing. Among 1,211,636 admissions, there were 323,220 (26.7%) deaths within 24 h; thus, 888,416 admissions (ICU, 212,059; HCU, 124,468; GW, 551,889) were analyzed. In-hospital mortality was 10.8%, 9.7%, and 12.2% for patients admitted to the ICU, HCU, and GW, respectively. Compared with the GW, the adjusted odds of death were lower for the ICU (odds ratio [OR] 0.718; 95% confidence interval [CI] 0.703-0.734) and HCU (OR 0.928; 95% CI 0.906-0.950). A higher number of board-certified cardiologists was independently associated with lower in-hospital mortality (OR 0.977 per additional board-certified cardiologist; 95% CI 0.976-0.978). Findings were consistent for acute myocardial infarction, acute heart failure, aortic dissection, and pulmonary embolism.
CONCLUSIONS: Higher-acuity admission and a higher number of cardiologists were independently associated with lower in-hospital mortality, supporting optimization of critical care access for high-risk cardiovascular emergencies in Japan.
METHODS AND RESULTS: Using the JROAD database, we identified patients hospitalized for cardiovascular emergencies after ambulance transport between April 2016 and March 2024 and classified patients by initial ward (intensive care unit [ICU], high care unit [HCU], or general ward [GW]). Deaths within 24 h were excluded. Multivariable logistic regression analysis was performed with adjustment for demographics, comorbidities, acute therapies, and hospital cardiologist staffing. Among 1,211,636 admissions, there were 323,220 (26.7%) deaths within 24 h; thus, 888,416 admissions (ICU, 212,059; HCU, 124,468; GW, 551,889) were analyzed. In-hospital mortality was 10.8%, 9.7%, and 12.2% for patients admitted to the ICU, HCU, and GW, respectively. Compared with the GW, the adjusted odds of death were lower for the ICU (odds ratio [OR] 0.718; 95% confidence interval [CI] 0.703-0.734) and HCU (OR 0.928; 95% CI 0.906-0.950). A higher number of board-certified cardiologists was independently associated with lower in-hospital mortality (OR 0.977 per additional board-certified cardiologist; 95% CI 0.976-0.978). Findings were consistent for acute myocardial infarction, acute heart failure, aortic dissection, and pulmonary embolism.
CONCLUSIONS: Higher-acuity admission and a higher number of cardiologists were independently associated with lower in-hospital mortality, supporting optimization of critical care access for high-risk cardiovascular emergencies in Japan.