July 9, 2007Archives of Internal Medicine
“America's Best Hospitals” in the Treatment of Acute Myocardial Infarction
Key result
Admission to a ranked hospital for acute myocardial infarction was associated with a lower risk-standardized 30-day mortality rate compared to nonranked hospitals (16.0% vs 17.9%, P<.001).
Why the study?
Does admission to a top-ranked hospital compared to a nonranked hospital reduce 30-day mortality in Medicare patients with acute myocardial infarction?
Population
268,569 Medicare patients with acute myocardial infarction treated in 2003
Comparison
Admission to a hospital ranked in 'America's… vs Admission to a nonranked hospital
Design
Cohort
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
Association with lower AMI mortality supports targeted investigation of ranked centers; should not yet guide individual referrals given observational design and performance overlap.
Study Design
Type
Observational (n=268,569)
Multicenter
Yes
Structured PICO
Does admission to a top-ranked hospital compared to a nonranked hospital reduce 30-day mortality in Medicare patients with acute myocardial infarction?
P
Population
268,569 Medicare patients with acute myocardial infarction treated at 50 ranked and 3,813 nonranked hospitals in 2003.
E
Exposure
Admission to a hospital ranked in 'America's Best Hospitals' by U.S. News & World Report for 'Heart and Heart Surgery'
C
Comparator
Admission to a nonranked hospital
O
Outcome
Risk-standardized, 30-day mortality rates (RSMRs)hard clinical
Main Result
Absolute Event Rate: 16% vs 17.9%
p-value: p=<.001
Admission to a top-ranked hospital for acute myocardial infarction is associated with a lower 30-day mortality rate on average, although there is significant overlap in performance with nonranked hospitals.
Cite This Study
Wang et al. (2007) conducted an observational in Acute myocardial infarction (AMI) (n=268,569). Admission to a ranked hospital vs. Admission to a nonranked hospital was evaluated on Risk-standardized 30-day mortality rate (RSMR) (p=<.001). Admission to a ranked hospital for acute myocardial infarction was associated with a lower risk-standardized 30-day mortality rate compared to nonranked hospitals (16.0% vs 17.9%, P<.001).