Abstract Body (Do not enter title and authors here): Background:
Hospital settings may influence outcomes in patients with cardiogenic shock (CS) complicating
acute myocardial infarction (AMI). Understanding these disparities is critical for improving care
delivery and resource allocations across different hospital settings.

Research Question:
Do teaching status and hospital location affect outcomes and resource use in patients with AMI-
CS?

Methods:
We extracted data from the National Inpatient Sample database from 2018 to 2020. We
included patients aged ≥18 years with AMI and CS listed as either a primary or secondary
diagnosis, identified using ICD-10-CM codes (AMI: I21.0–I21.4 and CS: R57.0). The primary
outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS), inflation-
adjusted hospital charges, mechanical circulatory support (MCS) use, acute kidney injury (AKI),
stroke, and septicemia. Multivariable logistic and linear regression models assessed
associations across urban teaching, urban non-teaching, and rural hospitals, adjusting for
patient and hospital-level factors.

Results:
Among 91,875 hospitalizations for AMI-CS, a significantly higher in-hospital mortality was
observed in rural hospitals compared to urban teaching hospitals (adjusted odds ratio [aOR]:
1.20, 95%CI: 1.0 to 1.4; P=0.03). Rural hospitals were associated with shorter LOS (β=-1.6;
95% CI: -2.1 to -1.2; P<0.01), lower MCS use (aOR: 0.62; 95%CI: 0.51 to 0.75; P<0.01), lower
hospital charges (β=-72,987; 95%CI: -85,134 to -60,840, P<0.01), and higher AKI (aOR:
0.74; 95% CI: 0.64 to 0.87; P<0.01) compared to urban teaching hospitals. There was no
significant difference in septicemia, and stroke between rural and urban teaching hospitals (both
P>0.05). Compared to urban teaching hospitals, urban non-teaching hospitals demonstrated
higher in-hospital mortality (OR: 1.09; 95% CI: 1.00 to 1.19; P=0.04), shorter LOS (β=-0.7;
95%CI: -1.1 to -0.4; P<0.01), lower MCS use (OR: 0.74; 95%CI: 0.67 to 0.82; P<0.01), and
lower hospital charges (β=-14,630; 95%CI: -26,525 to -2735; P=0.02). There was no
significant difference in AKI, septicemia, and stroke between urban teaching and non-teaching
hospitals. (all P>0.05).

Conclusions:
Rural and urban non-teaching hospitals demonstrated lower resource use and higher mortality
compared to urban teaching hospitals. Targeted quality improvement efforts and resource
allocations are needed to address disparities in care across hospital settings.