Relationship between annual volume of patients treated by admitting physician and mortality after acute myocardial...

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.