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Hospital Performance and Life Expectancy After MI
Study Questions:
What is the impact of hospital performance on long-term outcome of patients surviving myocardial infarction?
Methods:
The authors analyzed data from the Cooperative Cardiovascular Project, which was a study of Medicare beneficiaries who were hospitalized for acute myocardial infarction between 1994 and 1996, and who had 17 years of follow-up. Hospitals were grouped into five strata based on case-mix severity. Life expectancy among patients admitted to high-performing hospitals was compared with those admitted to low-performing hospitals. Hospital performance was defined by quintiles of 30-day risk-standardized mortality rates.
Results:
The study population was comprised of 119,735 patients with acute myocardial infarction who were admitted to 1,824 hospitals. There were significant differences in 30-day mortality based on hospital performance (as expected since hospitals were ranked on 30-day survival), but the survival curves then remained parallel over 17 years of follow-up. Estimated life expectancy declined as hospital risk-standardized mortality rate quintile increased, with patients treated at high-performing hospitals living between 0.74 and 1.14 years longer than patients treated at low-performing hospitals. Hospital performance had no impact on the survival of those who survived to 30 days.
Conclusions:
Patients treated at high-performing hospitals lived longer than those treated at low-performing hospitals, with the differences that emerged at 30 days being maintained over the study period.
Perspective:
This study reflects the outcome of patients treated in an era when reperfusion therapy was predominantly fibrinolysis and was not used consistently and rapidly at all hospitals. Similar findings were seen in the GISSI trial and other studies, where the benefits of reperfusion were evident by 30 days and were maintained over the long-term. The relevance of these data to contemporary practice is somewhat limited with the widespread use of, and the remarkable effectiveness of, primary percutaneous coronary intervention.
Keywords: Acute Coronary Syndrome, Fibrinolysis, Geriatrics, Hospital Mortality, Life Expectancy, Medicare, Myocardial Infarction, Percutaneous Coronary Intervention, Treatment Outcome
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