Key result
New Canadian AMI models improve 30-day mortality discrimination to a c-statistic of ~0.83 over existing tools.
Why the study?
Given changes in the care and outcomes of acute myocardial infarction patients over recent decades, updated prediction models were needed to generate accurate risk-adjusted mortality and readmission outcomes for Canadian hospitals.
Observational (n=153,523)
Yes
Newly developed risk-adjustment models for AMI mortality and readmission using contemporary Canadian administrative data demonstrated good discrimination and calibration, outperforming older models for profiling hospital performance.
May aid Canadian AMI hospital profiling; extends existing models but remains hypothesis-generating pending validation.
BACKGROUND: Given changes in the care and outcomes of acute myocardial infarction (AMI) patients over the past several decades, we sought to develop prediction models that could be used to generate accurate risk-adjusted mortality and readmission outcomes for hospitals in current practice across Canada. METHODS: A Canadian national expert panel was convened to define appropriate AMI patients for reporting and develop prediction models. Preliminary candidate variable evaluation was conducted using Ontario patients hospitalized with a most responsible diagnosis of AMI from April 1, 2015 to March 31, 2018. National data from the Canadian Institute for Health Information was used to develop AMI prediction models. The main outcomes were 30-day all-cause in-hospital mortality and 30-day urgent all-cause readmission. Discrimination of these models (measured by c-statistics) was compared with that of existing Canadian Institute for Health Information models in the same study cohort. RESULTS: The AMI mortality model was assessed in 54,240 Ontario AMI patients and 153,523 AMI patients across Canada. We observed a 30-day in-hospital mortality rate of 6.3%, and a 30-day all-cause urgent readmission rate of 10.7% in Canada. The final Canadian AMI mortality model included 12 variables and had a c-statistic of 0.834. For readmission, the model had 13 variables and a c-statistic of 0.679. Discrimination of the new AMI models had higher c-statistics compared with existing models (c-statistic 0.814 for mortality; 0.673 for readmission). CONCLUSIONS: In this national collaboration, we developed mortality and readmission models that are suitable for profiling performance of hospitals treating AMI patients in Canada.
No takes yet. Share an insight, caveat, or question.
Ko et al. (2021) conducted an observational in Acute Myocardial Infarction (n=153,523). New Canadian AMI prediction models vs. Existing CIHI models was evaluated on Discrimination (c-statistic) for 30-day in-hospital mortality. The newly developed Canadian AMI prediction models achieved higher discrimination for 30-day in-hospital mortality (c-statistic 0.834 vs 0.814) and 30-day urgent readmission (0.679 vs 0.673) compared to existing models.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: