From 1995 to 2006, hospital 30-day death rates decreased significantly for Medicare patients hospitalised for a heart attack, as did the variation in the rate between hospitals, according to a study in the 19 August 2009 issue of the Journal of the American Medical Association.
“Over the last two decades, health care professional, consumer, and payer organizations have sought to improve outcomes for patients hospitalised with acute myocardial infarction,” the authors wrote. However, little has been known about whether hospitals have been achieving better short-term mortality rates for infarction or if there has been a reduction in between-hospital variation in short-term mortality rates, according to background information in the article.
Harlan M Krumholz, Yale University School of Medicine, New Haven, US, and colleagues examined 30-day risk-standardised mortality rates for acute care hospitals in the US in the period between 1995 and 2006 for Medicare patients, 65 years or older (average age, 78 years) who were hospitalised with an myocardial infarction. The study included data on 3,195,672 discharges in 2,755,370 patients.
The researchers found that the all-cause and in-hospital death rates decreased over the study period. “The 30-day mortality rate decreased from 18.9% in 1995 to 16.1% in 2006, and in-hospital mortality decreased from 14.6% to 10.1%. In contrast, the 30-day mortality rate for all other conditions was 9% in 1995 and 8.6% in 2006.” The risk-standardised mortality rate, which takes into account the differences in the types of patients across hospitals and is currently being used by the Centers for Medicare and Medicaid Services to profile hospital performance, decreased from 18.8% in 1995 to 15.8% in 2006, and a reduction in between-hospital differences in mortality rates was also observed.
“Between 1995 and 2006, the risk-standardised mortality rates for patients admitted with infarction showed a marked and significant decrease, as did between-hospital variation. Although the cause of the reduction cannot be determined with certainty, this finding may reflect the success of the many individuals and organisations dedicated to improving care during this period,” the authors concluded.