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Relationship between annual volume of patients treated by admitting physician and mortality after acute myocardial
1Institute for Clinical Evaluative Sciences, G-106, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5. tu@ices.on.ca
Insights
Physician experience matters for acute myocardial infarction (AMI) survival. High-volume physicians treating more AMI cases annually are associated with lower patient mortality rates at 30 days and 1 year.
Area of Science:
- Cardiology
- Health Services Research
- Clinical Outcomes
Background:
- Acute myocardial infarction (AMI) is a prevalent condition.
- Physician experience in treating AMI varies, but its impact on patient outcomes is unclear.
Purpose of the Study:
- To investigate the association between the annual caseload of admitting physicians and patient mortality following AMI.
- To determine if higher physician volume correlates with improved survival rates after AMI.
Main Methods:
- Retrospective cohort study utilizing linked administrative databases in Ontario, Canada.
- Analysis of 98,194 patients treated by 5,374 physicians between 1992 and 1998.
- Risk-adjusted mortality rates (30-day and 1-year) were calculated based on physician volume and patient, physician, and hospital factors.
Main Results:
- A significant inverse relationship was found between physician annual AMI case volume and patient mortality.
- Physicians treating >24 AMI cases/year (highest quartile) had lower 30-day (11.8%) and 1-year (19.6%) risk-adjusted mortality compared to those treating ≤5 cases/year (lowest quartile: 15.3% and 24.2%, respectively).
- P-values were <.001 for both 30-day and 1-year mortality differences between quartiles.
Conclusions:
- Patients experiencing AMI have better survival outcomes when treated by high-volume physicians.
- Increased physician experience, indicated by higher annual AMI case volume, is linked to improved 30-day and 1-year survival rates.
Context:
Acute myocardial infarction (AMI) is a common condition that is treated by physicians with varying levels of clinical experience, but whether the level of experience affects outcome remains uncertain.
Objective:
To evaluate the relationship between the average annual volume of cases treated by admitting physicians and mortality after AMI.
Design, Setting, And Patients:
Retrospective cohort study using linked administrative databases containing patient admission information for 98 194 patients treated by 5374 physicians between April 1, 1992, and March 31, 1998, in Ontario, Canada.
Main Outcome Measures:
Mortality risk rates for 30 days and 1 year post-AMI, adjusted by physician volume and patient, physician, and hospital characteristics.
Results:
The 30-day mortality rate was 13.5% and the 1-year mortality rate was 21.8%. A strong inverse relationship between the average annual volume of AMI cases treated by the admitting physician and mortality after an AMI was observed. The 30-day risk-adjusted mortality rate was 15.3% for physicians who treated 5 or fewer AMI cases per year (lowest quartile) compared with 11.8% for physicians who treated more than 24 AMI cases annually (highest quartile; P<.001). The 1-year risk-adjusted mortality rate was 24.2% for physicians who treated 5 or fewer AMI cases per year (lowest quartile) compared with 19.6% for physicians who treated more than 24 AMI cases annually (highest quartile; P<.001).
Conclusion:
Patients with AMI who are treated by high-volume admitting physicians are more likely to survive at 30 days and 1 year.
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