| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 1999;99:2986-2992.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Comparing AMI Mortality Among Hospitals in Patients 65 Years of Age and Older
Evaluating Methods of Risk Adjustment
From the Sections of Cardiovascular Medicine, Department of Medicine (H.K., J.C., M.R.) and Chronic Disease Epidemiology, Department of Epidemiology and Public Health (H.K.), Yale University School of Medicine, New Haven, Conn; the Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Conn (H.K., M.R., Y.W., Y.-T.C.); Qualidigm, Middletown, Conn (H.K., M.R.); and the Health Care Financing Administration, Baltimore, Md (T.M.).
Background—Interest in the reporting of risk-adjusted outcomes for patients with acute myocardial infarction is growing. A useful risk-adjustment model must balance parsimony and ease of data collection with predictive ability.
Methods and Results—From our analysis of 82 359 patients
65 years of age admitted with acute myocardial infarction to 2401
hospitals, we derived a parsimonious model that predicts 30-day
mortality. The model was validated on a similar group of 78 699
patients from 2386 hospitals. Of the 73 candidate predictor
variables examined, 7 variables describing patient
characteristics on arrival were selected for inclusion in the final
model: age, cardiac arrest, anterior or lateral location of myocardial
infarction, systolic blood pressure, white blood cell count,
serum creatinine, and congestive heart failure. The area
under the receiver-operating characteristic curve for the final model
was 0.77 in the derivation cohort and 0.77 in the validation cohort.
The rankings of hospitals by performance (in deciles) with this
model were most similar to a comprehensive 27-variable model based
on medical chart review and least similar to models based on
administrative billing codes.
Conclusions—A simple 7-variable risk model performs as well as more complex models in comparing hospital outcomes for acute myocardial infarction. Although there is a continuing need to improve methods of risk adjustment, our results provide a basis for hospitals to develop a simple approach to compare outcomes.
Key Words: myocardial infarction • prognosis • mortality • risk factors • elderly
This article has been cited by other articles:
 |
|
 |
|
  T. E. Abrams, M. Vaughan-Sarrazin, and G. E. Rosenthal Psychiatric Comorbidity and Mortality After Acute Myocardial Infarction Circ Cardiovasc Qual Outcomes, May 1, 2009; 2(3): 213 - 220. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C P Gale, S O M Manda, C F Weston, J S Birkhead, P D Batin, and A S Hall Evaluation of risk scores for risk stratification of acute coronary syndromes in the Myocardial Infarction National Audit Project (MINAP) database Heart, February 1, 2009; 95(3): 221 - 227. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. R. Parikh, S. G. Coca, Y. Wang, F. A. Masoudi, and H. M. Krumholz Long-term Prognosis of Acute Kidney Injury After Acute Myocardial Infarction Arch Intern Med, May 12, 2008; 168(9): 987 - 995. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. K. Inrig, U. D. Patel, L. P. Briley, L. She, B. S. Gillespie, J. D. Easton, E. J. Topol, and L. A. Szczech Mortality, kidney disease and cardiac procedures following acute coronary syndrome Nephrol. Dial. Transplant., March 1, 2008; 23(3): 934 - 940. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. J. Stukenborg, D. P. Wagner, F. E. Harrell Jr, M. N. Oliver, S. W. Heim, A. L. Price, C. K. Han, A. M. D. Wolf, and A. F. Connors Jr Which Hospitals Have Significantly Better or Worse Than Expected Mortality Rates for Acute Myocardial Infarction Patients?: Improved Risk Adjustment With Present-at-Admission Diagnoses Circulation, December 18, 2007; 116(25): 2960 - 2968. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Lichtman, J. A. Spertus, K. J. Reid, M. J. Radford, J. S. Rumsfeld, N. B. Allen, F. A. Masoudi, W. S. Weintraub, and H. M. Krumholz Acute Noncardiac Conditions and In-Hospital Mortality in Patients With Acute Myocardial Infarction Circulation, October 23, 2007; 116(17): 1925 - 1930. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. A.A. Fox, J.-P. Bassand, S. R. Mehta, L. Wallentin, P. Theroux, L. S. Piegas, V. Valentin, T. Moccetti, S. Chrolavicius, R. Afzal, et al. Influence of Renal Function on the Efficacy and Safety of Fondaparinux Relative to Enoxaparin in Non ST-Segment Elevation Acute Coronary Syndromes Ann Intern Med, September 4, 2007; 147(5): 304 - 310. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. R. Rahimi, J. A. Spertus, K. J. Reid, S. M. Bernheim, and H. M. Krumholz Financial Barriers to Health Care and Outcomes After Acute Myocardial Infarction JAMA, March 14, 2007; 297(10): 1063 - 1072. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Alter, D. T. Ko, A. Newman, and J. V. Tu Factors explaining the under-use of reperfusion therapy among ideal patients with ST-segment elevation myocardial infarction Eur. Heart J., July 1, 2006; 27(13): 1539 - 1549. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. M. Krumholz, Y. Wang, J. A. Mattera, Y. Wang, L. F. Han, M. J. Ingber, S. Roman, and S.-L. T. Normand An Administrative Claims Model Suitable for Profiling Hospital Performance Based on 30-Day Mortality Rates Among Patients With an Acute Myocardial Infarction Circulation, April 4, 2006; 113(13): 1683 - 1692. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Mack, M. Herbert, S. Prince, T. M. Dewey, M. J. Magee, and J. R. Edgerton Does reporting of coronary artery bypass grafting from administrative databases accurately reflect actual clinical outcomes? J. Thorac. Cardiovasc. Surg., June 1, 2005; 129(6): 1309 - 1317. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Writing Committee Members, E. M. Antman, D. T. Anbe, P. W. Armstrong, E. R. Bates, L. A. Green, M. Hand, J. S. Hochman, H. M. Krumholz, F. G. Kushner, et al. ACC/AHA guidelines for the management of patients with ST-Elevation myocardial infarction--executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction) J. Am. Coll. Cardiol., August 4, 2004; 44(3): 671 - 719. [Full Text] [PDF]
|
|
|
|
|
|
E. M. Antman, D. T. Anbe, P. W. Armstrong, E. R. Bates, L. A. Green, M. Hand, J. S. Hochman, H. M. Krumholz, F. G. Kushner, G. A. Lamas, et al. ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction) Circulation, August 3, 2004; 110(5): 588 - 636. [Full Text] [PDF]
|
|
|
|
|
|
D. A. Morrow, E. M. Antman, S. A. Murphy, S. F. Assmann, R. P. Giugliano, C. P. Cannon, C. Michael Gibson, C. H. McCabe, H. V. Barron, F. Van de Werf, et al. The Risk Score Profile: a novel approach to characterising the risk of populations enrolled in clinical studies Eur. Heart J., July 1, 2004; 25(13): 1139 - 1145. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. A. Eagle, M. J. Lim, O. H. Dabbous, K. S. Pieper, R. J. Goldberg, F. Van de Werf, S. G. Goodman, C. B. Granger, P. G. Steg, J. M. Gore, et al. A Validated Prediction Model for All Forms of Acute Coronary Syndrome: Estimating the Risk of 6-Month Postdischarge Death in an International Registry JAMA, June 9, 2004; 291(22): 2727 - 2733. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. T. Ko, M. Mamdani, and D. A. Alter Lipid-Lowering Therapy With Statins in High-Risk Elderly Patients: The Treatment-Risk Paradox JAMA, April 21, 2004; 291(15): 1864 - 1870. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. S. Lee, P. C. Austin, J. L. Rouleau, P. P. Liu, D. Naimark, and J. V. Tu Predicting Mortality Among Patients Hospitalized for Heart Failure: Derivation and Validation of a Clinical Model JAMA, November 19, 2003; 290(19): 2581 - 2587. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. B. Granger, R. J. Goldberg, O. Dabbous, K. S. Pieper, K. A. Eagle, C. P. Cannon, F. Van de Werf, A. Avezum, S. G. Goodman, M. D. Flather, et al. Predictors of Hospital Mortality in the Global Registry of Acute Coronary Events Arch Intern Med, October 27, 2003; 163(19): 2345 - 2353. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Foody, F. D. Ferdinand, D. Galusha, S. S. Rathore, F. A. Masoudi, E. P. Havranek, D. Nilasena, M. J. Radford, and H. M. Krumholz Patterns of Secondary Prevention in Older Patients Undergoing Coronary Artery Bypass Grafting During Hospitalization for Acute Myocardial Infarction Circulation, September 9, 2003; 108(90101): II-24 - 28. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Spertus, M. J. Radford, N. R. Every, E. F. Ellerbeck, E. D. Peterson, and H. M. Krumholz Challenges and opportunities in quantifying the quality of care for acute myocardial infarction: Summary from the acute myocardial infarction working group of the American heart association/American college of cardiology first scientific forum on quality of care and outcomes research in cardiovascular disease and stroke J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1653 - 1663. [Full Text] [PDF]
|
|
|
|
|
|
C Mueller, F-J Neumann, A P Perruchoud, and H J Buettner White blood cell count and long term mortality after non-ST elevation acute coronary syndrome treated with very early revascularisation Heart, April 1, 2003; 89(4): 389 - 392. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Spertus, M. J. Radford, N. R. Every, E. F. Ellerbeck, E. D. Peterson, and H. M. Krumholz Challenges and Opportunities in Quantifying the Quality of Care for Acute Myocardial Infarction: Summary From the Acute Myocardial Infarction Working Group of the American Heart Association/American College of Cardiology First Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Circulation, April 1, 2003; 107(12): 1681 - 1691. [Full Text] [PDF]
|
|
|
|
|
|
R. V. Freeman, R. H. Mehta, W. Al Badr, J. V. Cooper, E. Kline-Rogers, and K. A. Eagle Influence of concurrent renal dysfunction on outcomes of patients with acute coronary syndromes and implications of the use of glycoprotein IIb/IIIa inhibitors J. Am. Coll. Cardiol., March 5, 2003; 41(5): 718 - 724. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. Rathore, K. P. Weinfurt, C. P. Gross, and H. M. Krumholz Validity of a Simple ST-Elevation Acute Myocardial Infarction Risk Index: Are Randomized Trial Prognostic Estimates Generalizable to Elderly Patients? Circulation, February 18, 2003; 107(6): 811 - 816. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J Harrop, R Donnelly, A Rowbottom, M Holt, and A R Scott Improvements in total mortality and lipid levels after acute myocardial infarction in an English health district (1995-1999) Heart, May 1, 2002; 87(5): 428 - 431. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. M. Krumholz, S. S. Rathore, J. Chen, Y. Wang, and M. J. Radford Evaluation of a Consumer-Oriented Internet Health Care Report Card: The Risk of Quality Ratings Based on Mortality Data JAMA, March 13, 2002; 287(10): 1277 - 1287. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. V. Barron, S. D. Harr, M. J. Radford, Y. Wang, and H. M. Krumholz The association between white blood cell count and acute myocardial infarction mortality in patients >=65 years of age: findings from the cooperative cardiovascular project J. Am. Coll. Cardiol., November 15, 2001; 38(6): 1654 - 1661. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Butler, R. Ness, and T. Speroff Improving Care for Elderly Patients With Peptic Ulcer Disease: Should the Focus Be on Drugs or Bugs? JAMA, October 24, 2001; 286(16): 2023 - 2024. [Full Text] [PDF]
|
|
|
|
|
|
D. A. Morrow, E. M. Antman, L. Parsons, J. A. de Lemos, C. P. Cannon, R. P. Giugliano, C. H. McCabe, H. V. Barron, and E. Braunwald Application of the TIMI Risk Score for ST-Elevation MI in the National Registry of Myocardial Infarction 3 JAMA, September 19, 2001; 286(11): 1356 - 1359. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Mehta, S. S. Rathore, M. J. Radford, Y. Wang, Y. Wang, and H. M. Krumholz Acute myocardial infarction in the elderly: differences by age J. Am. Coll. Cardiol., September 1, 2001; 38(3): 736 - 741. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M F Dorsch, R A Lawrance, R J Sapsford, J Oldham, D C Greenwood, B M Jackson, C Morrell, S G Ball, M B Robinson, and A S Hall A simple benchmark for evaluating quality of care of patients following acute myocardial infarction Heart, August 1, 2001; 86(2): 150 - 154. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Chen, S. S. Rathore, M. J. Radford, Y. Wang, and H. M. Krumholz Racial Differences in the Use of Cardiac Catheterization after Acute Myocardial Infarction N. Engl. J. Med., May 10, 2001; 344(19): 1443 - 1449. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. V. Tu, P. C. Austin, R. Walld, L. Roos, J. Agras, and K. M. McDonald Development and validation of the ontario acute myocardial infarction mortality prediction rules J. Am. Coll. Cardiol., March 15, 2001; 37(4): 992 - 997. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. G. Jollis and P. S. Romano Volume-Outcome Relationship in Acute Myocardial Infarction: The Balloon and the Needle JAMA, December 27, 2000; 284(24): 3169 - 3171. [Full Text] [PDF]
|
|
|
|
|
|
D. A. Morrow, E. M. Antman, A. Charlesworth, R. Cairns, S. A. Murphy, J. A. de Lemos, R. P. Giugliano, C. H. McCabe, and E. Braunwald TIMI Risk Score for ST-Elevation Myocardial Infarction: A Convenient, Bedside, Clinical Score for Risk Assessment at Presentation : An Intravenous nPA for Treatment of Infarcting Myocardium Early II Trial Substudy Circulation, October 24, 2000; 102(17): 2031 - 2037. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Allison, C. I. Kiefe, N. W. Weissman, S. D. Person, M. Rousculp, J. G. Canto, S. Bae, O. D. Williams, R. Farmer, and R. M. Centor Relationship of Hospital Teaching Status With Quality of Care and Mortality for Medicare Patients With Acute MI JAMA, September 13, 2000; 284(10): 1256 - 1262. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. C. Gan, S. K. Beaver, P. M. Houck, R. F. MacLehose, H. W. Lawson, and L. Chan Treatment of Acute Myocardial Infarction and 30-Day Mortality among Women and Men N. Engl. J. Med., July 6, 2000; 343(1): 8 - 15. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Measuring and Improving Quality of Care : A Report From the American Heart Association/American College of Cardiology First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and Stroke Stroke, April 1, 2000; 31(4): 1002 - 1012. [Full Text] [PDF]
|
|
|
|
|
|
Measuring and Improving Quality of Care : A Report From the American Heart Association/American College of Cardiology First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and Stroke Circulation, March 28, 2000; 101(12): 1483 - 1493. [Full Text] [PDF]
|
|