Does More Intensive Treatment of Acute Myocardial Infarction in the Elderly Reduce Mortality?
Analysis Using Instrumental Variables
Bibliographic Data
| ID | 23367227 |
|---|---|
| Authors | Mark Mcclellan (0000-0001-6636-5238, Harvard University, corresponding author) |
| Year | 1994 |
| Volume | 272 |
| Issue | 11 |
| Pages | 859 |
| Publication date | 1994-09-21 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | JAMA (JOURNAL) |
| Journal identifiers | ISSN: 0098-7484 • E-ISSN: 1538-3598 |
| Publisher | American Medical Association (AMA) (PUBLISHER) |
| DOI | 10.1001/jama.1994.03520110039026 |
| PMID | 8078163 |
| OpenAlex | W1989190276 |
| Language | EN |
| Citations received | 75 |
| References cited | 3 |
OBJECTIVE: To determine the effect of more intensive treatments on mortality in elderly patients with acute myocardial infarction (AMI). DESIGN: Analysis of incremental treatment effects using differential distances as instrumental variables to account for unobserved case-mix variation (selection bias) in observational Medicare claims data (1987 through 1991). MAIN OUTCOME MEASURES: Survival to 4 years after AMI. RESULTS: Patients who receive different treatments differ in observable and unobservable health characteristics, biasing estimates of treatment effects based on standard methods of adjusting for observable differences. Patients' differential distances to alternative types of hospitals are strong independent predictors of how intensively an AMI patient will be treated and appear uncorrelated with health status. Thus, differential distances approximately randomize patients to different likelihoods of receiving intensive treatments. Comparisons of patient groups that differ only in differential distances show that the impact on mortality at 1 to 4 years after AMI of the incremental ("marginal") use of invasive procedures in Medicare patients was at most 5 percentage points; this gain was achieved during the first day of hospitalization and therefore appears attributable to treatments other than the procedures. Admission to a hospital treating a high volume of AMI patients was associated with an effect on mortality at 4 years of less than 1 percentage point, again arising on day 1. Patients living in rural areas experienced acute mortality that was an additional 0.6 percentage-point higher, after controlling for less access to intensive treatments. CONCLUSIONS: For elderly patients with AMI, the aspects of treatment most affecting long-term survival relate to care within the first 24 hours of admission. The survival benefits from greater use of catheterization and revascularization procedures appear minimal in marginal patients.
Differential treatment · Intensive care · Intensive care medicine · Mortality rate · Myocardial infarction · Observational study · Selection bias · Acute Myocardial Infarction Research · Advanced Causal Inference Techniques · Emergency Medicine · Internal Medicine · Medicine · Primary Care and Health Outcomes
Natural Experiments in the Social Sciences
Stature and long-term labor market outcomes
The impact of hospices on health care expenditures-the case of Taiwan
Does prenatal care improve birth outcomes? A critical review
Cardiac Procedure Use and Outcomes in Elderly Patients with Acute Myocardial Infarction in the United States and Quebec, Canada, 1988 to 1994
Outcomes of Acute Myocardial Infarction in the Department of Veterans Affairs
Relationship of Provider Characteristics To Outcomes, Process, And Costs of Care for Community-Acquired Pneumonia
Posthospitalization Home Health Care Use and Changes in Functional Status in a Medicare Population
Common Methodological Terms in Health Services Research and Their Symptoms
Impact of Geographic Proximity to Cardiac Revascularization Services on Service Utilization
Geographic Access to Family Planning Facilities and the Risk of Unintended and Teenage Pregnancy
Evidence-Based Critical Care
Instrumental Variables in Statistics and Econometrics
Statistical Analysis
Mostly Harmless Econometrics
Better Late Than Nothing
Does Medicare Save Lives?
Validating recommendations for coronary angiography following acute myocardial infarction in the elderly
The Implications of Regional Variations in Medicare Spending. Part 2
The Implications of Regional Variations in Medicare Spending. Part 1
Association of Rural Hospital Admissions with Access, Treatment, and Mortality for Patients with Acute Myocardial Infarction in Shanxi, China
The Price Effect of Hospital Closures
The Impact of Nurse Practitioner-Led Primary Care on Quality and Cost for Medicaid-Enrolled Patients in States With Pay Parity
Is Health Contagious?—Based on Empirical Evidence From China Family Panel Studies' Data
Assessing the extent to which network structure causes people to be perceived as a leader
Birth models of care and intervention rates
The diffusion of robotic surgery
The political economy of health epidemics
Do Physicians Warm Up to Higher Medicare Prices? Evidence from Alaska
Does visitation in prison reduce recidivism
The effect of a middle grades STEM initiative on students’ cognitive and non-cognitive outcomes
The Research‐Treatment Distinction
Control, Exogeneity, and Directness
Distance, Use of Resources, and Mortality Among Rural Missouri Residents With Acute Myocardial Infarction
Hospital Allocation and Racial Disparities in Health Care
Productivity Spillovers in Health Care
Measuring Returns to Hospital Care
A Review on Methods of Risk Adjustment and their Use in Integrated Healthcare Systems
Causal effects of foster care
Does childhood schooling affect old age memory or mental status? Using state schooling laws as natural experiments
Confounding by indication in non-experimental evaluation of vaccine effectiveness
Using natural experiments to evaluate population health interventions
Sorting or mixing? Multi‐track and single‐track schools and social inequalities in a differentiated educational system
The influence of state policy and proximity to medical services on health outcomes
The timing of preventive services for women and children
The distance to community medical care and the likelihood of hospitalization
Association of Perceived Neighborhood Safety on Body Mass Index
The potential impact of comparative effectiveness research on U.S. Health Care expenditures
A New Method to Isolate Local-Area Practice Styles in Prescription Use as the Basis for Instrumental Variables in Comparative Effectiveness Research
The Effect of Acupuncture Utilization on Healthcare Utilization
The Effect of Medicare Annual Wellness Visits on Breast Cancer Screening and Diagnosis
Hormone Replacement Therapy and Cardiovascular Health in the United States
Very Low Birth Weight Hospital Volume and Mortality
Outcome of Patients With Cardiac Diseases Admitted to Coronary Care Units
Race/Ethnic Disparities in Utilization of Lifesaving Technologies by Medicare Ischemic Heart Disease Beneficiaries
The Role of Long-term Acute Care Hospitals in Treating the Critically Ill and Medically Complex
Understanding the Relationship Between Nursing Home Experience With Human Immunodeficiency Virus and Patient Outcomes
Team Structure and Adverse Events in Home Health Care
Potentially Inappropriate Medication Use and Healthcare Expenditures in the US Community-Dwelling Elderly
The Identification Process Using Choice Theory Is Needed to Match Design With Objectives in CER
Conditions for Generating Treatment Effect Estimates in Line With Objectives
Heterogeneity and the Interpretation of Treatment Effect Estimates From Risk Adjustment and Instrumental Variable Methods
Hospital Revisits Within 30 Days After Conventional and Robotically Assisted Hysterectomy
Identifying Appropriate Reference Data Models for Comparative Effectiveness Research (CER) Studies Based on Data from Clinical Information Systems
Handle with Care
The Empirical Economist's Toolkit
Examining Distance Effects on Hospitalizations Using GIS
What drives labor market losses among diabetics-physiological impairment or psychosocial burden? New evidence from triangulation
Hospital competition and health outcomes
The crowding-out effects of tobacco and alcohol where expenditure shares are low
Private provider incentives in health care
What happens when the tasks dry up? Exploring the impact of medical technology on workforce planning
The Effect of Registered Nurses' Unions on Heart-Attack Mortality
Walking the Tightrope on Medicare Reform
The Pragmatist's Guide to Comparative Effectiveness Research
| Unique citing works | 75 |
|---|---|
| Citations per year | 2,42 |
| Citation span | 1995 - 2026 (32) |
| Citation velocity | current |
| Highly cited | No |
| Citation types | Neutral: 65 |