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October 17, 2017Annals of Internal MedicineOpen Access

Age Differences in Hospital Mortality for Acute Myocardial Infarction: Implications for Hospital Profiling

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Why the study?

Does hospital performance profiling based on older patients with AMI accurately reflect performance for younger patients?

Population

543,794 adults hospitalized for acute myocardial infarction from 1 October 2010 to 30 September 2014 across…

Comparison

Hospital performance profiling based on 30-day… vs Hospital performance profiling based on 30-day…

Design

Cohort

Follow-up

30-day

Authors

KDKumar DharmarajanRMRobert L. McNamaraYWYongfei Wang

Discussion

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Overview

Hospital AMI mortality rankings from older patients may not reflect younger adults; leaves open need for age-specific measures in profiling.

Structured PICO

Does hospital performance profiling based on older patients with AMI accurately reflect performance for younger patients?

P
Population
543,794 adults hospitalized for acute myocardial infarction (AMI) from 1 October 2010 to 30 September 2014 across 986 U.S. hospitals in the ACTION Registry-Get With the Guidelines (267,763 aged ≥65 years and 276,031 aged 18 to 64 years).
I
Intervention
Hospital performance profiling based on 30-day risk-standardized mortality rates (RSMRs) for older patients (aged ≥65 years).
C
Comparator
Hospital performance profiling based on 30-day RSMRs for younger patients (aged 18 to 64 years) and all patients (aged ≥18 years).
O
Outcome
Agreement in hospital rankings and correlation in hospital AMI achievement scores based on 30-day RSMRs.hard clinical

Hospital mortality rankings for older patients with AMI correlate weakly with rankings for younger patients, indicating that Medicare-based profiling may not accurately reflect overall hospital quality for younger populations.

Limitations

  • Minority of U.S. hospitals.

Cite This Study

Dharmarajan et al. (2017) studied this question.

synapsesocial.com/papers/6a72c2cb5d37378ac1df689fhttps://doi.org/10.7326/m16-2871
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Characteristics, Treatment Practices, and In‐Hospital Outcomes of Older Adults Hospitalized with Acute Myocardial Infarction2014 · 11 citations
  2. 2Reduction in Acute Myocardial Infarction Mortality in the United States2009 · 260 citations
  3. 3Management and Outcome of Acute Myocardial Infarction in Older Patients in the Thrombolytic Era1999 · 10 citations
  4. 4Risk Factors & In-Hospital Outcome of Acute ST Segment Elevation Myocardial Infarction among Young (<40 Years) versus Older (>40 Years) Patients: A Comparative Study2025
  5. 5Twenty-Year Trends in Outcomes for Older Adults With Acute Myocardial Infarction in the United States2019 · 178 citations