Hospital Variation in Mortality After First Acute Myocardial Infarction in Denmark From 1995 to 2002

Lower Short-Term and 1-Year Mortality in High-Volume and Specialized Hospitals

Datos Bibliográficos

ID9104080
AutoresSoren Rasmussen (Rigshospitalet, autor de correspondencia), Ann-Dorthe O Zwisler, Ann‐Dorthe Zwisler (0000-0002-9241-2090, Danish National Institute of Public Health, autor de correspondencia), Steen Z Abildstrom (Danish National Institute of Public Health, autor de correspondencia), Jan Kyst Madsen, Mette Madsen (Danish National Institute of Public Health, autor de correspondencia)
Año2005
Volumen43
Número10
Páginas970-978
Fecha de publicación2005-10-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/01.mlr.0000178195.07110.d3
PMID16166866
OpenAlexW2065832587
IdiomaEN
Citas recibidas8
Referencias citadas34

BACKGROUND: This study used linked data from the National Hospital Registry to determine the factors that contribute to differences between hospitals in all-cause mortality after first acute myocardial infarction (AMI) between 1995 and 2002. METHODS: The study included 64,321 patients with their first admission for AMI between 1995 and 2002 and surviving the day of admission. Multilevel logistic regression was used to determine the relationships between regional and hospital characteristics and 28-day and 365-day mortality after adjusting for individual characteristics, period, and medical history. RESULTS: Tertiary cardiac care centers (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.67-0.96) and main regional hospitals (OR, 0.90; 95% CI, 0.80-0.99) had improved 28-day mortality compared with local hospitals. A 2-fold increase in annual total MI volume decreased 28-day mortality (OR, 0.91; 95% CI, 0.87-0.94) and 365-day mortality (OR, 0.95; 95% CI, 0.91-0.98). Differences between hospitals were more substantial for short-term mortality, such that patients were about twice as likely to die within 28 days in hospitals with the worst performance versus those with the best performance. Higher regional AMI incidence was associated with lower mortality before 2000; this disappeared after 2000. Other regional contextual characteristics had very modest effects on mortality. CONCLUSIONS: Type of hospital, and especially total MI volume at the hospital level, were significantly associated with mortality after AMI. Individual hospitals varied substantially in both short- and long-term mortality

Confidence interval · Incidence (geometry) · Logistic regression · Mortality rate · Myocardial infarction · Odds ratio · Standardized mortality ratio · Acute Myocardial Infarction Research · Cardiac Health and Mental Health · Demography · Emergency Medicine · Internal Medicine · Medicine · Sepsis Diagnosis and Treatment