Age Differences in Hospital Mortality for Acute Myocardial Infarction: Implications for Hospital Profiling
Kumar Dharmarajan1, Robert L McNamara1, Yongfei Wang1
1From Clover Health, Jersey City, New Jersey; Center for Outcomes Research & Evaluation, Yale New Haven Health, and Yale School of Medicine, New Haven, Connecticut; University of Colorado Anschutz Medical Campus, Denver, Colorado; University of Texas Southwestern Medical Center and American Heart Association, Dallas, Texas; Ronald Reagan UCLA Medical Center, Los Angeles, California; Stanford University Medical Center, Palo Alto, California; Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and American College of Cardiology, Washington, DC.
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.
Insights
Hospital mortality rates for older acute myocardial infarction (AMI) patients do not consistently reflect those for younger patients. This suggests age-related quality differences in AMI care may exist.
Area of Science:
- Cardiology
- Health Services Research
- Quality Improvement
Background:
- Publicly reported hospital mortality rates for acute myocardial infarction (AMI) primarily focus on Medicare beneficiaries, potentially excluding outcomes for younger populations.
- Existing metrics may not fully capture the spectrum of patient outcomes across different age groups.
Purpose of the Study:
- To investigate the relationship between hospital 30-day risk-standardized mortality rates (RSMRs) for older (≥65 years) and younger (18-64 years) acute myocardial infarction (AMI) patients.
- To assess the correlation between hospital performance rankings for these age groups and for all patients (≥18 years).
Main Methods:
- A retrospective cohort study analyzed data from 986 hospitals within the ACTION Registry-Get With the Guidelines.
- Hospital 30-day RSMRs for AMI were calculated for older, younger, and all patients using an electronic health record measure.
- Hospitals were ranked based on RSMRs, and correlations in performance scores were examined using the Hospital Value-Based Purchasing (HVBP) Program method.
Main Results:
- The study identified over 543,000 AMI hospitalizations. Median 30-day RSMRs were 9.4% for older patients, 3.0% for younger patients, and 6.2% for all patients.
- A minority of hospitals consistently ranked as top or bottom performers for both older and younger AMI patients.
- Hospital Value-Based Purchasing achievement scores showed weak correlation between older and younger patients (R=0.30) but strong correlation between older and all patients (R=0.92).
Conclusions:
- Hospital mortality rankings for older AMI patients do not reliably reflect performance for younger patients.
- There is a need to incorporate younger patient outcomes into hospital quality assessments to identify and address potential age-related disparities in care.
- Further research is warranted to understand the nuances of age-specific quality differences in acute myocardial infarction management.
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