Home > Acute coronary syndrome, Uncategorized > Hospital Choice & Life Expectancy After Myocardial Infarction

Hospital Choice & Life Expectancy After Myocardial Infarction

Bucholz et al report an analysis of data from the Cooperative Cardiovascular Project (of Medicare beneficiaries hospitalized for myocardial infarction with acute myocardial infarction between 1994 and 1996). The authors classified hospital performance based on quintiles of 30-day mortaility for acute myocardial infarction. Cox proportional hazard models with stratification by case-mix was used to calculate life expectancy (area under survival curve: 17 year follow up). There was a gradient of life expectancy with hospital performance quintile across all case mix. The case mix strata had the expected gradient of life expectancy (healthiest best LE, east healthy worst).

Abstract

BACKGROUND

Thirty-day risk-standardized mortality rates after acute myocardial infarction are
commonly used to evaluate and compare hospital performance. However, it is not
known whether differences among hospitals in the early survival of patients with
acute myocardial infarction are associated with differences in long-term survival.

METHODS

We analyzed data from the Cooperative Cardiovascular Project, a study of Medicare
beneficiaries who were hospitalized for acute myocardial infarction between 1994
and 1996 and who had 17 years of follow-up. We grouped hospitals into five
strata that were based on case-mix severity. Within each case-mix stratum, we
compared life expectancy among patients admitted to high-performing hospitals
with life expectancy among patients admitted to low-performing hospitals. Hospital
performance was defined by quintiles of 30-day risk-standardized mortality
rates. Cox proportional-hazards models were used to calculate life expectancy.

RESULTS

The study sample included 119,735 patients with acute myocardial infarction who
were admitted to 1824 hospitals. Within each case-mix stratum, survival curves of
the patients admitted to hospitals in each risk-standardized mortality rate quintile
separated within the first 30 days and then remained parallel over 17 years of
follow-up. Estimated life expectancy declined as hospital risk-standardized mortality
rate quintile increased. On average, patients treated at high-performing
hospitals lived between 0.74 and 1.14 years longer, depending on hospital case
mix, than patients treated at low-performing hospitals. When 30-day survivors
were examined separately, there was no significant difference in unadjusted or
adjusted life expectancy across hospital risk-standardized mortality rate quintiles.

CONCLUSIONS

In this study, patients admitted to high-performing hospitals after acute myocardial
infarction had longer life expectancies than patients treated in low-performing
hospitals. This survival benefit occurred in the first 30 days and persisted over the
long term.
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