Key result
Admission in 2009 vs 2000 is linked to ~41% lower 30-day post-discharge mortality for AMI.
Observational (n=263,746)
Yes
Relative Risk: 0.41 (95% CI 0.38–0.45)
The decline in hospital mortality in acutely admitted older patients between 2000 and 2009 was largely driven by lower in-hospital mortality, highlighting the importance of separately reporting in-hospital and post-discharge mortality rates.
Mortality reductions in older acute admissions should not yet change practice; leaves open drivers of in-hospital versus post-discharge gains.
OBJECTIVES: to compare changes over time in the in-hospital mortality and the mortality from discharge to 30 days post-discharge for six highly prevalent discharge diagnoses in acutely admitted older patients as well as to assess the effect of separately analysing the in-hospital mortality and the mortality from discharge to 30 days post-discharge. STUDY DESIGN AND SETTING: retrospective analysis of Dutch hospital and mortality data collected between 2000 and 2010. SUBJECTS: the participants included 263,746 people, aged 65 years and above, who were acutely admitted for acute myocardial infarction (AMI), heart failure (HF), stroke, chronic obstructive pulmonary disease, pneumonia or hip fracture. METHODS: we compared changes in the in-hospital mortality and mortality from discharge to 30 days post-discharge in the Netherlands using a logistic- and a multinomial regression model. RESULTS: for all six diagnoses, the mortality from admission to 30 days post-discharge declined between 2000 and 2009. The decline ranged from a relative risk ratio (RRR) of 0.41 [95% confidence interval (CI) 0.38-0.45] for AMI to 0.77 [0.73-0.82] for HF. In separate analyses, the in-hospital mortality decreased for all six diagnoses. The mortality from discharge to 30 days post-discharge in 2009 compared to 2000 depended on the diagnosis, and either declined, remained unchanged or increased. CONCLUSIONS: the decline in hospital mortality in acutely admitted older patients was largely attributable to the lower in-hospital mortality, while the change in the mortality from discharge to 30 days post-discharge depended on the diagnosis. Separately reporting the two rate estimates might be more informative than providing an overall hospital mortality rate.
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Rijn et al. (2016) conducted an observational in Acute myocardial infarction, heart failure, stroke, chronic obstructive pulmonary disease, pneumonia, or hip fracture (n=263,746). Admission in 2009 vs. Admission in 2000 was evaluated on Mortality from admission to 30 days post-discharge (RRR 0.41 (for AMI), 95% CI 0.38-0.45). Admission in 2009 compared to 2000 was associated with lower mortality from admission to 30 days post-discharge across six diagnoses, with RRRs ranging from 0.41 for AMI to 0.77 for HF.
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