The ACTION Registry-GWTG in-hospital mortality risk model for myocardial infarction (MI) patients has been updated to include cardiac arrest and has been validated as a robust instrument for risk adjustment and benchmarking of mortality outcomes, according to a study published Aug. 1 in the Journal of the American College of Cardiology.

Using data from the ACTION Registry-GWTG, researchers examined the records of 243,440 patients from 655 hospitals between January 2012 and December 2013 to create the risk model. The new model replaces an earlier version, which was based on 2007 and 2008 data, and now includes age; heart rate; systolic blood pressure; presentation after cardiac arrest, in cardiogenic shock, or in heart failure; type of MI; and the blood levels of creatinine and troponin.

Results showed that the overall in-hospital mortality rate was 4.6 percent. The risk scores varied considerably, ranging from a less than 1 percent chance of dying for younger MI patients without other risk factors and not experiencing cardiac arrest to a more than 50 percent chance of dying for older patients with many other risk factors and presenting after cardiac arrest.

Robert McNamara, MD, MHS, FACC, the study’s lead author, says the model performed well across a broad range of subgroups, including those with and without cardiac arrest and with and without other high-risk characteristics, illustrating the value of the model for benchmarking mortality outcomes even for hospitals caring for different types of patients. He adds that “adjusting for cardiac arrest among heart patients is critically important and enables a fairer assessment for hospitals that care for these patients.” Furthermore, the model should enhance research into best practices to further reduce mortality in MI patients, he notes.    

In an accompanying editorial, Peter W.F. Wilson, MD, and Ralph B. D’Agostino Sr., PhD, explain that the study’s results show “the dynamic nature of health risk appraisals,” in that there is now “extensive information related to risk factors, recent medications, a history of coronary disease, and severity of clinical presentation” available in the hospital setting.   

Keywords: Benchmarking, Blood Pressure, Coronary Disease, Creatinine, Health Status Indicators, Heart Arrest, Heart Failure, Heart Rate, Hospital Mortality, Myocardial Infarction, Registries, Risk Adjustment, Risk Factors, Shock, Cardiogenic, Troponin, Troponin, National Cardiovascular Data Registries, ACTION Registry

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