Hospital 30-Day Outcomes Post-MI, Patient Life Expectancy Linked

Larry Hand

October 06, 2016

BOSTON, MA — Patients treated in hospitals with low 30-day mortality rates may expect to live about a year longer than patients treated at low-performing hospitals, according to research published in the October 6, 2016 issue of the New England Journal of Medicine[1].

Dr Emily M Bucholz (Boston Children's Hospital, MA) and colleagues analyzed data from the Cooperative Cardiovascular Project on 119,735 Medicare beneficiaries hospitalized between 1994 and 1996 for MI in 1824 hospitals.

The researchers stratified the hospitals according to five case-mix strata, with the first representing hospitals admitting the healthiest patients and the fifth representing hospitals admitting the sickest patients. They then compared life expectancy within each stratum, using quintiles of 30-day risk-standardized mortality rates to define hospital-performance quality over 17 years of follow-up.

They found that as hospital mortality rate quintile increased, life expectancy declined. Patients treated at hospitals with the highest performance for 30-day mortality lived, on average, 0.74 to 1.14 years longer than patients treated at low-performing hospitals.

Life-expectancy differences across risk-standardized mortality rate quintiles were significant in all five case-mix strata (P<0.001 for all).

"The bottom line is where you go for treatment really does matter, and not just for surviving the early period, but really that benefit persists over the long term," Bucholz told heartwire from Medscape.

"Interestingly, we found that these short-term metrics really do translate into meaningful patient gains and survival," she said. "Hospitals aren't just keeping patients alive in the short term, they're keeping patients who may have otherwise died healthier over the long term.

"This study provides further evidence that these short-term quality metrics are really important for hospitals to pay attention to. A lot more information is needed as to what are the initiatives that are most important," she added.

"Hospitals are keeping sick patients alive during that first 30 days and setting them up for success down the road," she concluded.

The National Heart, Lung, and Blood Institute and the National Institute of General Medical Sciences funded this research. Bucholz reports grant support from the National Heart, Lung, and Blood Institute and the National Institute of General Medical Sciences during the conduct of the study. Disclosures for the coauthors are listed on the journal website.

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