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Do "America's Best Hospitals" perform better for acute myocardial infarction?
1Department of Medicine, Yale University School of Medicine, New Haven, CT 06520-8025, USA.
Insights
Patients admitted to top-ranked cardiology hospitals had lower 30-day mortality from acute myocardial infarction. This survival benefit was partly attributed to higher use of aspirin and beta-blocker therapies in these leading hospitals.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Hospital Quality Assessment
Background:
- The U.S. News and World Report "America's Best Hospitals" list ranks healthcare facilities.
- It remains unclear if top-ranked cardiology hospitals reduce short-term mortality for acute myocardial infarction (AMI).
- The role of recommended therapies in explaining mortality differences is also unknown.
Purpose of the Study:
- To investigate whether admission to top-ranked cardiology hospitals is associated with lower short-term mortality in elderly AMI patients.
- To determine if differences in the use of recommended therapies explain any observed mortality variations.
- To compare outcomes across top-ranked, similarly equipped, and non-similarly equipped hospitals.
Main Methods:
- Analysis of 149,177 elderly Medicare beneficiaries with AMI from the Cooperative Cardiovascular Project (1994-1995).
- Comparison of 30-day mortality, aspirin, beta-blocker, and reperfusion therapy use.
- Categorization of hospitals into top-ranked cardiology, similarly equipped (cardiac facilities), and non-similarly equipped.
Main Results:
- Admission to top-ranked hospitals was linked to lower adjusted 30-day mortality (OR, 0.87; P=0.05).
- Top-ranked hospitals showed higher aspirin (96.2%) and beta-blocker (75.0%) use but lower reperfusion rates (61.0%).
- The survival advantage diminished after adjusting for aspirin and beta-blocker use (OR, 0.94; P=0.38).
Conclusions:
- Hospitals ranked high in "America's Best Hospitals" cardiology list were associated with reduced 30-day mortality for elderly AMI patients.
- Higher utilization of aspirin and beta-blocker therapies in top-ranked hospitals may account for a significant portion of this survival benefit.
- These findings highlight the importance of adherence to evidence-based therapies in improving outcomes for acute myocardial infarction.
Background:
"America's Best Hospitals," an influential list published annually by U.S. News and World Report, assesses the quality of hospitals. It is not known whether patients admitted to hospitals ranked at the top in cardiology have lower short-term mortality from acute myocardial infarction than those admitted to other hospitals or whether differences in mortality are explained by differential use of recommended therapies.
Methods:
Using data from the Cooperative Cardiovascular Project on 149,177 elderly Medicare beneficiaries with acute myocardial infarction in 1994 or 1995, we examined the care and outcomes of patients admitted to three types of hospitals: those ranked high in cardiology (top-ranked hospitals); hospitals not in the top rank that had on-site facilities for cardiac catheterization, coronary angioplasty, and bypass surgery (similarly equipped hospitals); and the remaining hospitals (non-similarly equipped hospitals). We compared 30-day mortality; the rates of use of aspirin, beta-blockers, and reperfusion; and the relation of differences in rates of therapy to short-term mortality.
Results:
Admission to a top-ranked hospital was associated with lower adjusted 30-day mortality (odds ratio, 0.87; 95 percent confidence interval, 0.76 to 1.00; P=0.05 for top-ranked hospitals vs. the others). Among patients without contraindications to therapy, top-ranked hospitals had significantly higher rates of use of aspirin (96.2 percent, as compared with 88.6 percent for similarly equipped hospitals and 83.4 percent for non-similarly equipped hospitals; P<0.01) and beta-blockers (75.0 percent vs. 61.8 percent and 58.7 percent, P<0.01), but lower rates of reperfusion therapy (61.0 percent vs. 70.7 percent and 65.6 percent, P=0.03). The survival advantage associated with admission to top-ranked hospitals was less strong after we adjusted for factors including the use of aspirin and beta-blockers (odds ratio, 0.94; 95 percent confidence interval, 0.82 to 1.08; P=0.38).
Conclusions:
Admission to a hospital ranked high on the list of "America's Best Hospitals" was associated with lower 30-day mortality among elderly patients with acute myocardial infarction. A substantial portion of the survival advantage may be associated with these hospitals' higher rates of use of aspirin and beta-blocker therapy.