Age differences in hospital mortality for acute myocardial infarction: Implications for hospital profiling

Kumar Dharmarajan, Robert L. McNamara, Yongfei Wang, Frederick A. Masoudi, Joseph S. Ross, Erica E. Spatz, Nihar R. Desai, James A de Lemos, Gregg C. Fonarow, Paul A. Heidenreich, Deepak L. Bhatt, Susannah M. Bernheim, Lara E. Slattery, Yosef M. Khan, Jeptha P. Curtis

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Publicly reported hospital risk-standardized mortality rates (RSMRs) for acute myocardial infarction (AMI) are calculated for Medicare beneficiaries. Outcomes for older patients with AMI may not reflect general outcomes. Objective: To examine the relationship between hospital 30- day RSMRs for older patients (aged ≥65 years) and those for younger patients (aged 18 to 64 years) and all patients (aged ≥18 years) with AMI. Design: Retrospective cohort study. Setting: 986 hospitals in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry-Get With the Guidelines. Participants: Adults hospitalized for AMI from 1 October 2010 to 30 September 2014. Measurements: Hospital 30-day RSMRs were calculated for older, younger, and all patients using an electronic health record measure of AMI mortality endorsed by the National Quality Forum. Hospitals were ranked by their 30-day RSMRs for these 3 age groups, and agreement in rankings was plotted. The correlation in hospital AMI achievement scores for each age group was also calculated using the Hospital Value-Based Purchasing (HVBP) Program method computed with the electronic health record measure. Results: 267 763 and 276 031 AMI hospitalizations among older and younger patients, respectively, were identified. Median hospital 30-day RSMRs were 9.4%, 3.0%, and 6.2% for older, younger, and all patients, respectively. Most top- and bottom-performing hospitals for older patients were neither top nor bottom performers for younger patients. In contrast, most top and bottom performers for older patients were also top and bottom performers for all patients. Similarly, HVBP achievement scores for older patients correlated weakly with those for younger patients (R = 0.30) and strongly with those for all patients (R = 0.92). Limitation: Minority of U.S. hospitals. Conclusion: Hospital mortality rankings for older patients with AMI inconsistently reflect rankings for younger patients. Incorporation of younger patients into assessment of hospital outcomes would permit further examination of the presence and effect of age-related quality differences. Primary Funding Source: American College of Cardiology.

Original languageEnglish (US)
Pages (from-to)555-564
Number of pages10
JournalAnnals of Internal Medicine
Volume167
Issue number8
DOIs
StatePublished - Oct 17 2017

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Hospital Mortality
Myocardial Infarction
Mortality
Value-Based Purchasing
Electronic Health Records
Age Groups
Medicare
Registries

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Dharmarajan, K., McNamara, R. L., Wang, Y., Masoudi, F. A., Ross, J. S., Spatz, E. E., ... Curtis, J. P. (2017). Age differences in hospital mortality for acute myocardial infarction: Implications for hospital profiling. Annals of Internal Medicine, 167(8), 555-564. https://doi.org/10.7326/M16-2871

Age differences in hospital mortality for acute myocardial infarction : Implications for hospital profiling. / Dharmarajan, Kumar; McNamara, Robert L.; Wang, Yongfei; Masoudi, Frederick A.; Ross, Joseph S.; Spatz, Erica E.; Desai, Nihar R.; de Lemos, James A; Fonarow, Gregg C.; Heidenreich, Paul A.; Bhatt, Deepak L.; Bernheim, Susannah M.; Slattery, Lara E.; Khan, Yosef M.; Curtis, Jeptha P.

In: Annals of Internal Medicine, Vol. 167, No. 8, 17.10.2017, p. 555-564.

Research output: Contribution to journalArticle

Dharmarajan, K, McNamara, RL, Wang, Y, Masoudi, FA, Ross, JS, Spatz, EE, Desai, NR, de Lemos, JA, Fonarow, GC, Heidenreich, PA, Bhatt, DL, Bernheim, SM, Slattery, LE, Khan, YM & Curtis, JP 2017, 'Age differences in hospital mortality for acute myocardial infarction: Implications for hospital profiling', Annals of Internal Medicine, vol. 167, no. 8, pp. 555-564. https://doi.org/10.7326/M16-2871
Dharmarajan, Kumar ; McNamara, Robert L. ; Wang, Yongfei ; Masoudi, Frederick A. ; Ross, Joseph S. ; Spatz, Erica E. ; Desai, Nihar R. ; de Lemos, James A ; Fonarow, Gregg C. ; Heidenreich, Paul A. ; Bhatt, Deepak L. ; Bernheim, Susannah M. ; Slattery, Lara E. ; Khan, Yosef M. ; Curtis, Jeptha P. / Age differences in hospital mortality for acute myocardial infarction : Implications for hospital profiling. In: Annals of Internal Medicine. 2017 ; Vol. 167, No. 8. pp. 555-564.
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abstract = "Background: Publicly reported hospital risk-standardized mortality rates (RSMRs) for acute myocardial infarction (AMI) are calculated for Medicare beneficiaries. Outcomes for older patients with AMI may not reflect general outcomes. Objective: To examine the relationship between hospital 30- day RSMRs for older patients (aged ≥65 years) and those for younger patients (aged 18 to 64 years) and all patients (aged ≥18 years) with AMI. Design: Retrospective cohort study. Setting: 986 hospitals in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry-Get With the Guidelines. Participants: Adults hospitalized for AMI from 1 October 2010 to 30 September 2014. Measurements: Hospital 30-day RSMRs were calculated for older, younger, and all patients using an electronic health record measure of AMI mortality endorsed by the National Quality Forum. Hospitals were ranked by their 30-day RSMRs for these 3 age groups, and agreement in rankings was plotted. The correlation in hospital AMI achievement scores for each age group was also calculated using the Hospital Value-Based Purchasing (HVBP) Program method computed with the electronic health record measure. Results: 267 763 and 276 031 AMI hospitalizations among older and younger patients, respectively, were identified. Median hospital 30-day RSMRs were 9.4{\%}, 3.0{\%}, and 6.2{\%} for older, younger, and all patients, respectively. Most top- and bottom-performing hospitals for older patients were neither top nor bottom performers for younger patients. In contrast, most top and bottom performers for older patients were also top and bottom performers for all patients. Similarly, HVBP achievement scores for older patients correlated weakly with those for younger patients (R = 0.30) and strongly with those for all patients (R = 0.92). Limitation: Minority of U.S. hospitals. Conclusion: Hospital mortality rankings for older patients with AMI inconsistently reflect rankings for younger patients. Incorporation of younger patients into assessment of hospital outcomes would permit further examination of the presence and effect of age-related quality differences. Primary Funding Source: American College of Cardiology.",
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AU - McNamara, Robert L.

AU - Wang, Yongfei

AU - Masoudi, Frederick A.

AU - Ross, Joseph S.

AU - Spatz, Erica E.

AU - Desai, Nihar R.

AU - de Lemos, James A

AU - Fonarow, Gregg C.

AU - Heidenreich, Paul A.

AU - Bhatt, Deepak L.

AU - Bernheim, Susannah M.

AU - Slattery, Lara E.

AU - Khan, Yosef M.

AU - Curtis, Jeptha P.

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N2 - Background: Publicly reported hospital risk-standardized mortality rates (RSMRs) for acute myocardial infarction (AMI) are calculated for Medicare beneficiaries. Outcomes for older patients with AMI may not reflect general outcomes. Objective: To examine the relationship between hospital 30- day RSMRs for older patients (aged ≥65 years) and those for younger patients (aged 18 to 64 years) and all patients (aged ≥18 years) with AMI. Design: Retrospective cohort study. Setting: 986 hospitals in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry-Get With the Guidelines. Participants: Adults hospitalized for AMI from 1 October 2010 to 30 September 2014. Measurements: Hospital 30-day RSMRs were calculated for older, younger, and all patients using an electronic health record measure of AMI mortality endorsed by the National Quality Forum. Hospitals were ranked by their 30-day RSMRs for these 3 age groups, and agreement in rankings was plotted. The correlation in hospital AMI achievement scores for each age group was also calculated using the Hospital Value-Based Purchasing (HVBP) Program method computed with the electronic health record measure. Results: 267 763 and 276 031 AMI hospitalizations among older and younger patients, respectively, were identified. Median hospital 30-day RSMRs were 9.4%, 3.0%, and 6.2% for older, younger, and all patients, respectively. Most top- and bottom-performing hospitals for older patients were neither top nor bottom performers for younger patients. In contrast, most top and bottom performers for older patients were also top and bottom performers for all patients. Similarly, HVBP achievement scores for older patients correlated weakly with those for younger patients (R = 0.30) and strongly with those for all patients (R = 0.92). Limitation: Minority of U.S. hospitals. Conclusion: Hospital mortality rankings for older patients with AMI inconsistently reflect rankings for younger patients. Incorporation of younger patients into assessment of hospital outcomes would permit further examination of the presence and effect of age-related quality differences. Primary Funding Source: American College of Cardiology.

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