Variation in Hospital Mortality Rates for Patients With Acute Myocardial Infarction

• Published in: The American journal of cardiology Vol. 106; no. 8; pp. 1108 - 1112
• Main Authors: Bradley, Elizabeth H., Herrin, Jeph, Curry, Leslie, Cherlin, Emily J., Wang, Yongfei, Webster, Tashonna R., Drye, Elizabeth E., Normand, Sharon-Lise T., Krumholz, Harlan M.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.10.2010; Elsevier; Elsevier Limited
• Subjects: Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Censuses; Coronary heart disease; Heart; Heart attacks; Hospital Mortality - trends; Hospitals; Hospitals - statistics & numerical data; Humans; Medical sciences; Mortality; Multivariate analysis; Myocardial Infarction - mortality; Myocarditis. Cardiomyopathies; Patients; Retrospective Studies; Socioeconomic factors; Survival Analysis; United States - epidemiology; United States; United States > US; Human; Myocardial infarction; Prognosis; Acute; Mortality; Rate; Variations; Cardiovascular disease; Patient; Coronary heart disease; Myocardial disease; Circulatory system; Hospital; Cardiology
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2010.06.014

Hospitals vary by twofold in their hospital-specific 30-day risk-stratified mortality rates (RSMRs) for Medicare beneficiaries with acute myocardial infarction (AMI). However, we lack a comprehensive investigation of hospital characteristics associated with 30-day RSMRs and the degree to which the variation in 30-day RSMRs is accounted for by these characteristics, including the socioeconomic status (SES) profile of hospital patient populations. We conducted a cross-sectional national study of hospitals with ≥15 AMI discharges from July 1, 2005 to June 20, 2008. We estimated a multivariable weighted regression using Medicare claims data for hospital-specific 30-day RSMRs, American Hospital Association Survey of Hospitals for hospital characteristics, and the United States Census data reported by Neilsen Claritas, Inc., for zip-code level estimates of SES status. Analysis included 2,908 hospitals with 513,202 AMI discharges. Mean hospital 30-day RSMR was 16.5% (SD 1.7 percentage points). Our multivariable model explained 17.1% of the variation in hospital-specific 30-day RSMRs. Teaching status, number of hospital beds, AMI volume, cardiac facilities available, urban/rural location, geographic region, ownership type, and SES profile of patients were significantly (p <0.05) associated with 30-day RSMRs. In conclusion, substantial variation in hospital outcomes for patients with AMI remains unexplained by measurements of hospital characteristics including SES patient profile.