Association Between Initial Admission Ward and In-Hospital Mortality Among Patients Hospitalized for Cardiovascular Emergencies ― A Nationwide Study Using the JROAD-DPC Database ―
Abstract
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.
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BibTeX
@article{kuwabara2026association,
title = {{Association Between Initial Admission Ward and In-Hospital Mortality Among Patients Hospitalized for Cardiovascular Emergencies ― A Nationwide Study Using the JROAD-DPC Database ―}},
author = {Masanari Kuwabara and Takeshi Yamamoto and Yoshio Tahara and Migaku Kikuchi and Hiroshi Imamura and Ichiro Takeuchi and Naoki Sato and Tomonori Itoh and Yoko Sumita and Yoshihiro Miyamoto and Shiro Ishihara and Kikuo Isoda and Tomoko Ishizu and Yuji Ikari and Shuzou Tanimoto and Yae Matsuo and Ryosuke Murai and Takanori Ikeda and Hiroyuki Okura and Yoshio Kobayashi and Kuniya Asai and on behalf of Japanese Circulation Society Emergency and Critical Care Committee},
journal = {Circulation Journal},
year = {2026},
month = jul,
doi = {10.1253/circj.cj-26-0310},
url = {https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0310/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Association Between Initial Admission Ward and In-Hospital Mortality Among Patients Hospitalized for Cardiovascular Emergencies ― A Nationwide Study Using the JROAD-DPC Database ―
AU - Masanari Kuwabara
AU - Takeshi Yamamoto
AU - Yoshio Tahara
AU - Migaku Kikuchi
AU - Hiroshi Imamura
AU - Ichiro Takeuchi
AU - Naoki Sato
AU - Tomonori Itoh
AU - Yoko Sumita
AU - Yoshihiro Miyamoto
AU - Shiro Ishihara
AU - Kikuo Isoda
AU - Tomoko Ishizu
AU - Yuji Ikari
AU - Shuzou Tanimoto
AU - Yae Matsuo
AU - Ryosuke Murai
AU - Takanori Ikeda
AU - Hiroyuki Okura
AU - Yoshio Kobayashi
AU - Kuniya Asai
AU - on behalf of Japanese Circulation Society Emergency and Critical Care Committee
PY - 2026
DA - 2026/07/31
JO - Circulation Journal
DO - 10.1253/circj.cj-26-0310
UR - https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0310/_article
AB - 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.
SN - 1347-4820
SN - 1346-9843
ER -