TY - JOUR
T1 - Age differences in hospital mortality for acute myocardial infarction
T2 - Implications for hospital profiling
AU - Dharmarajan, Kumar
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.
N1 - Funding Information:
This research was supported by the American College of Cardiology Foundation's National Cardiovascular Data Registry. The National Cardiovascular Data Registry research committee reviewed the final manu-
Funding Information:
Financial Support: By the American College of Cardiology. At the time this research was done, Dr. Dharmarajan was supported by grant K23AG048331 from the National Institute on Aging and the American Federation for Aging Research through the Paul B. Beeson Emerging Leaders Career Development Award program. He was also supported by grant P30AG021342 via the Yale Claude D. Pepper Older Americans Independence Center. Drs. Spatz and Desai are supported by grant K12HS023000 from the Agency for Healthcare Research and Quality. Dr. Curtis is supported by grant 1U01HL105270 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views or policies of the American College of Cardiology, Department of Health and Human Services, National Institutes of Health, or American Federation for Aging Research.
PY - 2017/10/17
Y1 - 2017/10/17
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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85031920926&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85031920926&partnerID=8YFLogxK
U2 - 10.7326/M16-2871
DO - 10.7326/M16-2871
M3 - Article
C2 - 28973634
AN - SCOPUS:85031920926
SN - 0003-4819
VL - 167
SP - 555
EP - 564
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 8
ER -