JAMA: Hospitalization lowers death rate of acute MI patients

Dr. Harlan M. Krumholz Image source: Yale University

Hospital 30-day death rates decreased significantly for Medicare patients hospitalized for MI, as did the variation in the rate between hospitals, according to a study in the Aug. 19 issue of the Journal of American Medical Association.

“Over the last two decades, healthcare professional, consumer and payor organizations have sought to improve outcomes for patients hospitalized with acute MI,” the authors wrote. “However, little has been known about whether hospitals have been achieving better short-term mortality rates for acute MI or if there has been a reduction in between-hospital variation in short-term mortality rates.”

Harlan M. Krumholz, MD, of Yale University School of Medicine in New Haven, Conn., and colleagues examined the 30-day risk-standardized mortality rates in acute-care U.S. hospitals between 1995 and 2006 for Medicare patients, 65 years or older (average age, 78 years) who were hospitalized with an acute MI. The study included data on 3.2 million discharges in 2.76 million patients.

The researchers found that the all-cause and in-hospital death rates decreased over the study period. “The 30-day mortality rate decreased from 18.9 percent in 1995 to 16.1 percent in 2006, and in-hospital mortality decreased from 14.6 percent to 10.1 percent,” they wrote. “In contrast, the 30-day mortality rate for all other conditions was 9 percent in 1995 and 8.6 percent in 2006.”

According to the authors, the risk-standardized mortality rates, which take into account the differences in the types of patients across hospitals and is currently being used by the Centers for Medicare & Medicaid Services (CMS) to profile hospital performance, decreased from 18.8 percent in 1995 to 15.8 percent in 2006, and a reduction in between-hospital differences in mortality rates was also observed.

“Between 1995 and 2006, the risk-standardized mortality rates for patients admitted with acute MI showed a marked and significant decrease, as did between-hospital variation,” Krumholz and colleagues concluded. “Although the cause of the reduction cannot be determined with certainty, this finding may reflect the success of the many individuals and organizations dedicated to improving care during this period.”