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Hospital mortality rates declined in patients with acute MI, but cause is uncertain
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Hospital mortality rates for Medicare patients hospitalized with acute MI decreased between 1995 and 2006.
Researchers evaluated 3,195,672 discharges in 2,755,370 Medicare patients discharged with acute MI who were hospitalized in nonfederal acute care hospitals. The primary outcome measure was hospital-specific, 30-day all-cause mortality rates.
According to the results, the observed 30-day all-cause mortality rates decreased from 18.9% in 1995 to 16.1% in 2006. In-hospital mortality decreased from 14.6% to 10.1% during the same period. The odds of dying after being treated in a hospital one standard deviation (SD) above the national average relative to the odds of dying when treated in a hospital one SD below the national average were 1.63 (95% CI, 1.60-1.65) in 1995 vs. 1.56 (95% CI, 1.53-1.60) in 2006.
The hospital-specific, 30-day all-cause mortality rate declined from 18.8% in 1995 to 15.8% in 2006 (OR=0.76; 95% CI, 0.75-0.77. The researchers also reported that the West South Central region of the United States had the largest absolute reduction (3.6%) in hospital-specific, 30-day all-cause mortality between 1995 and 2006 (from 19.8% to 16.2%), whereas the Pacific region had the smallest absolute reduction (1.9%) between 1995 and 2006 (from 17.8% to 15.9%).
“Between 1995 and 2006, the [hospital-specific, 30-day all-cause mortality rate] for patients admitted with acute MI showed a marked and significant decrease, as did between-hospital variation,” the researchers concluded. “Although the cause of the reduction cannot be determined with certainty, this finding may reflect the success of the many individuals and organizations dedicated to improving care during this period.”
In a statement released by the Society for Cardiovascular Angiography, president Steven R. Bailey, MD, commended the results of the study and urged continued vigilance in the effort to drive mortality rates down further.
“The significant advances we’ve seen in heart attack care, including angioplasty and the door-to-balloon initiative to treat heart attack patients more quickly, are true success stories of modern medicine,” Bailey, who also serves as chief of the division of cardiology at the University of Texas Health Sciences Center in San Antonio, said in the statement. “While advances in CV care have helped save countless lives in the past decades, heart disease remains the number one killer in America. With an increased focus on health reform, it’s vitally important we continue to provide innovative treatment options to save lives and improve quality of life for heart disease patients.”
Krumholz HM. JAMA. 2009;302:767-773.