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Author Notes:

A.A. Kolkailah, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America. Email: ahmed.kolkailah@utsouthwestern.edu

Ahmed Kolkailah: Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data Curation, Writing - Original Draft, Review & Editing, Visualization Marwan Abougergi: Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data Curation, Writing - Review & Editing Parth Desai: Methodology, Validation, Axi Patel: Methodology, Validation Setri Fugar: Writing - Review & Editing Alexis Okoh: Writing -Review & Editing Ahmed Al-Ogaili: Writing - Review & Editing Sameer Hirji: Writing - Review & Editing Tsuyoshi Kaneko: Writing - Review & Editing Annabelle Santos Volgman: Writing - Review & Editing Rami Doukky: Writing - Review & Editing Justin Grodin: Writing - Review & Editing Darren McGuire: Validation, Writing - Review & Editing, Supervision, Project administration.

Dr. Kolkailah and Dr. Okoh were supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Numbers T32HL125247 and T32HL130025, respectively. The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institutes of Health.

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Subject:

Keywords:

  • Heart failure
  • July effect
  • Outcomes

Does the "July effect" of new trainees at teaching hospitals impact outcomes for patients hospitalized with heart failure? Real-world analyses of more than half a million US admissions.

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Journal Title:

Am Heart J Plus

Volume:

Volume 13

Publisher:

Type of Work:

Article | Post-print: After Peer Review

Abstract:

INTRODUCTION: The "July effect" refers to the potential of adverse clinical outcomes related to the annual turnover of trainees. We investigated whether this impacts inpatient heart failure (HF) outcomes. METHODS: Data from all adults (≥18 years) admitted with a primary diagnosis of HF at US teaching hospitals from the 2012-2014 National Inpatient Sample were analyzed. Non-teaching hospital admissions were excluded. The primary outcome was in-hospital mortality. Secondary metrics included hospital length of stay (LOS) and total cost adjusted for inflation. Logistic and linear regression models were used to adjust for confounders. Admissions were classified into 4 quarters (Q1-Q4), based on the academic calendar. Q1 and Q4 were designated to assess the effect of novice (July effect) versus experienced trainees, respectively. RESULTS: There were 699,675 HF admissions during Q1 and Q4 in the study period. Mean age was 71 ± 15 years and 48% were females. There were 20,270 in-hospital deaths, with no difference between Q1 and Q4; crude odds ratio (OR) 1.00, 95% confidence interval (CI) 0.94-1.07, p = 0.95. After risk adjustment, there was no in-hospital mortality difference between Q1 and Q4 admissions; adjusted OR 0.96, 95% CI 0.89-1.03, p = 0.23. There was no difference in hospital LOS or total cost; 5.8 versus 5.8 days, p = 0.66 and $13,755 versus $13,586, p = 0.46, in Q1 and Q4, respectively. CONCLUSIONS: In this nationally representative sample, there was no evidence of a "July effect" on inpatient HF outcomes in the US. This suggests that HF patients should not delay seeking care during trainee transitions at teaching hospitals.

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This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/rdf).
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