{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T18:30:06Z","timestamp":1780943406367,"version":"3.54.1"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Patients hospitalized with acute myocardial infarction (AMI) have a high mortality rate. Despite increasing recognition of the role for comfort focused care, little is known about the prevalence of comfort measures only (CMO) care among patients with AMI. The objective of this study was to investigate patient- and hospital-level patterns and predictors of CMO care among patients admitted with AMI.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>This retrospective cohort study used the National Cardiovascular Data Registry Chest Pain-MI Registry, which contains data on patients admitted with AMI. Data were analyzed in 6-month increments from January 2015 to June 2018.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Among 483\u2009696 patients with AMI across 827 hospitals, 13\u2009955 (2.9%) had CMO status at discharge (2.6% non\u2013ST-segment\u2013elevation myocardial infarction and 3.4% ST-segment\u2013elevation myocardial infarction). There was a modest decline in CMO rates over time (3.0% to 2.8%). Independent patient characteristics associated with CMO status included male gender, White race, nonprivate insurance, frailty, and higher estimated bleeding and mortality risks. There was substantial variation in CMO rates across hospitals, with the proportion of CMO patients ranging from 0% to 17.1% and a median odds ratio of 1.59 (95% CI, 1.56\u20131.62). Among the 13\u2009955 patients who were CMO by discharge, 8134 (58.3%) underwent diagnostic catheterization. This is despite significantly elevated risks predicted using precatheterization models, specifically the ACTION Registry GWTG in-hospital major bleeding and mortality risk scores. Patients who were initially managed invasively but later made CMO experienced high rates of procedural complications, including cardiogenic shock (38.3%), dialysis (10.1%), and bleeding (33.3%).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Most patients with AMI who were CMO by discharge had aggressive initial management and became CMO following in-hospital complications of their care. Early identification of high-risk patients and appropriate transition of such patients to CMO, if aligned with their values, remain important areas for future quality programs in AMI.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.120.007610","type":"journal-article","created":{"date-parts":[[2022,1,18]],"date-time":"2022-01-18T19:01:11Z","timestamp":1642532471000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Comfort Measures Only in Myocardial Infarction: Prevalence of This Status, Change Over Time, and Predictors From a Nationwide Study"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7857-0789","authenticated-orcid":true,"given":"Leila","family":"Haghighat","sequence":"first","affiliation":[{"name":"Division of Cardiology, University of California, San Francisco (UCSF), CA (L.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9168-2470","authenticated-orcid":true,"given":"Samuel W.","family":"Reinhardt","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine (S.W.R., N.R.D.), Yale New Haven Hospital, New Haven, CT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle L.","family":"Saly","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Brigham and Women\u2019s Hospital, Boston, MA (D.L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Lu","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (D.L., T.Y.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0271-5400","authenticated-orcid":true,"given":"Roland A.","family":"Matsouaka","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (D.L., T.Y.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2384-2545","authenticated-orcid":true,"given":"Nihar R.","family":"Desai","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine (S.W.R., N.R.D.), Yale New Haven Hospital, New Haven, CT."},{"name":"Center for Outcomes Research and Evaluation (N.R.D.), Yale New Haven Hospital, New Haven, CT."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2010.07.023"},{"key":"e_1_3_3_3_2","unstructured":"NCDR. Coder\u2019s Data Dictionary v3.0. 2019. Accesssed January 31 2021. https:\/\/cvquality.acc.org\/docs\/default-source\/ncdr\/registries\/cpmi_v3-0_datadictionarycoderspecifications_04262019_edit.pdf?sfvrsn=9df786bf_0."},{"key":"e_1_3_3_4_2","unstructured":"Joint Commission. Comfort measures only. Specifications Manual for Joint Commission National Quality Measures (v2018A). 2018. 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