Key result
Higher ED admission rates for chest pain linked to ~6 fewer AMIs and deaths per 1,000.
Why the study?
Do higher ED admission rates reduce 30-day acute myocardial infarction and mortality in Medicare beneficiaries presenting with chest pain?
Observational (n=158,295)
Yes
Do higher ED admission rates reduce 30-day acute myocardial infarction and mortality in Medicare beneficiaries presenting with chest pain?
Hospitals with higher emergency department admission rates for Medicare patients presenting with chest pain have lower 30-day rates of acute myocardial infarction and mortality.
Answers are grounded in this paper and cite their sources.
May support higher admission thresholds for Medicare chest pain; leaves open causality and optimal strategies pending trials.
OBJECTIVES: The objective was to assess the relationship between emergency department (ED) admission rates for Medicare beneficiaries with chest pain and outcomes, specifically 30-day rates of acute myocardial infarction (AMI) and mortality. METHODS: Using a 20% random sample of Medicare beneficiaries in 2009, 158,295 beneficiaries with a primary diagnosis of chest pain at the conclusion of their ED visits were selected to assess outcomes based on the decision to hospitalize or discharge home. The proportions of these patients admitted to inpatient or observation status at 2,219 U.S. hospitals were calculated, adjusting for differences in patient and hospital characteristics. Both bivariate analysis and multivariable logistic regression were used to estimate the effect of the adjusted admission rates (designed to be a measure of care intensity) on patient outcomes. Other covariates in the multivariable model included patient demographics, medical conditions, and hospital utilization in the 30 days prior to the ED visits. Results from the bivariate and multivariable analyses were compared for consistency. RESULTS: The adjusted Medicare admission rate for ED patients with chest pain averaged 63% for the middle quintile of the patient sample and ranged from 38% to 81% in the lowest and highest quintiles. The multivariable model yielded estimates of 3.6 fewer cases of AMI (95% confidence interval [CI] = 1.5 to 5.1 cases) and 2.8 fewer deaths (95% CI = 0.6 to 4.1 deaths) per 1,000 chest pain patients associated with an admission rate of 81% versus 38%. The estimates from the bivariate analysis were of similar magnitude. CONCLUSIONS: Considerable variation exists across U.S. hospitals in ED admission rates for Medicare patients with chest pain. Hospitals that approach admissions more conservatively (i.e., higher admission rates) in this population have lower rates of AMI and mortality.
No takes yet. Share an insight, caveat, or question.
Cotterill et al. (2015) conducted an observational in Chest pain (n=158,295). Higher ED admission rate (81%) vs. Lower ED admission rate (38%) was evaluated on 30-day rates of acute myocardial infarction (AMI) and mortality (3.6 fewer AMIs and 2.8 fewer deaths per 1,000, 95% CI 1.5 to 5.1 (AMI); 0.6 to 4.1 (mortality)). Higher ED admission rates for Medicare patients with chest pain were associated with 3.6 fewer AMIs and 2.8 fewer deaths per 1,000 patients at 30 days.
Synapse has enriched 10 related papers. Consider them for comparative context: