Reduced between-hospital variation in short term survival after acute myocardial infarction: the result of improved cardiac care?

Abstract

Objectives: To re-examine interhospital variation in 30 day survival after acute myocardial infarction (AMI) 10 years on to see whether the appointment of new cardiologists and their involvement in emergency care has improved outcome after AMI. Design: Retrospective cohort study. Setting: Acute hospitals in Scotland. Participants: 61 484 patients with a first AMI over two time periods: 1988-1991; and 1998-2001. Main outcome measures: 30 day survival. Results: Between 1988 and 1991, median 30 day survival was 79.2% (interhospital range 72.1-85.1%). The difference between highest and lowest was 13.0 percentage points (age and sex adjusted, 12.1 percentage points). Between 1998 and 2001, median survival rose to 81.6% (and range decreased to 78.0-85.6%) with a difference of 7.6 (adjusted 8.8) percentage points. Admission hospital was an independent predictor of outcome at 30 days during the two time periods (p , 0.001). Over the period 1988-1991, the odds ratio for death ranged, between hospitals, from 0.71 (95% confidence interval (CI) 0.58 to 0.88) to 1.50 (95% CI 1.19 to 1.89) and for the period 1998-2001 from 0.82 (95% CI 0.60 to 1.13) to 1.46 (95% CI 1.07 to 1.99). The adjusted risk of death was significantly higher than average in nine of 26 hospitals between 1988 and 1991 but in only two hospitals between 1998 and 2001. Conclusions: The average 30 day case fatality rate after admission with an AMI has fallen substantially over the past 10 years in Scotland. Between-hospital variation is also considerably less notable because of better survival in the previously poorly performing hospitals. This suggests that the greater involvement of cardiologists in the management of AMI has paid dividends.

Using nationwide ‘big data’ from linked electronic health records to help improve outcomes in cardiovascular diseases: 33 studies using methods from epidemiology, informatics, economics and social science in the ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER) programme

“…[428][429][430][431][432] In other studies, attention focused on hospitals grouped by academic status, geographical region or receipt of achievement awards, not on individual hospitals within these groupings. 431,433,434 Selection at patient level often means that whole segments of the population are excluded, with many studies confining their analyses to patients aged ≥ 65 years 428,430,432 or to STEMI patients. 429,431,433 Across all studies, patient-level data are sparse, with some studies providing information about demographic factors only 435 and most providing little information about infarct severity.…”

“…429,431,433 Across all studies, patient-level data are sparse, with some studies providing information about demographic factors only 435 and most providing little information about infarct severity. [429][430][431][432][433][435][436][437][438] Information about in-hospital treatments is nearly always absent 428,430,432,434,435,437 or, when available, has not been used to inform individual hospital performance. 429,431,433 We have sought to address these limitations using data from the UK, one of the few countries in which all hospitals participate in a national registry of patients admitted with AMI (MINAP), which records data on case mix, treatment and mortality.…”

Effects of exercise-based cardiac rehabilitation on cardiorespiratory fitness: A meta-analysis of UK studies

“…[6][7][8] Few data from the United Kingdom (UK) are included in the evidence-base, and the combined data from randomised controlled trials performed in the UK [5, 9,10] provide no evidence that exercise-based CR reduces mortality or morbidity. In recent years, improvements in acute and preventative coronary care [11] have increased the pool of patients eligible for CR. Improved life expectancy results in patients living longer with established conditions including cardiovascular disease (CVD), thus, a greater emphasis on 'softer' endpoints such as enhanced quality of life [12,13] and improved fitness has been required [12,14].…”

Influence of hyperbaric oxygenation treatment (HBOT) on clinical outcomes (recurrent myocardial infarction and survival rate) during five-year monitoring period after acute myocardial infarction

“…Several bodies of evidences indicate a decrease in cases of cardiovascular mortality in developed countries in the last decade. Approximately 20% -30% accounting for this decrease is due to the better quality of medical measures, while the remaining 70% -80% reflects the effectiveness of rehabilitation program on primary prophylactics of atherosclerosis [6][7][8]. However, the effectiveness of the secondary prophylactics of atherosclerosis is lower and, particularly, the post-MI survivors retain the risky "hallmark" for recurrent myocardial infarction (rMI) and cardiovascular related mortality [9,10].…”