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Death Rate decreases following
hospitalization for Heart Attack
Newswise — From 1995 to 2006, hospital
30-day death rates decreased significantly
for Medicare patients hospitalized for a
heart attack, as did the variation in the
rate between hospitals, according to a study
in the August 19 issue of JAMA.
"Over the last 2 decades, health care
professional, consumer, and payer
organizations have sought to improve
outcomes for patients hospitalized with
acute myocardial infarction [AMI; heart
attack]," the authors write.
However, little has been known about whether
hospitals have been achieving better
short-term mortality rates for AMI or if
there has been a reduction in
between-hospital variation in short-term
mortality rates, according to background
information in the article.
Harlan M. Krumholz, M.D., S.M., of Yale
University School of Medicine, New Haven,
Conn., and colleagues examined 30-day
risk-standardized mortality rates (RSMRs)
for acute care hospitals in the United
States in the period between 1995 and 2006
for Medicare patients, 65 years or older
(average age, 78 years) who were
hospitalized with an AMI. The study included
data on 3,195,672 discharges in 2,755,370
patients.
The researchers found that the all-cause and
in-hospital death rates decreased over the
study period.
"The 30-day mortality rate decreased from
18.9 percent in 1995 to 16.1 percent in
2006, and in-hospital mortality decreased
from 14.6 percent to 10.1 percent.
"In
contrast, the 30-day mortality rate for all
other conditions was 9.0 percent in 1995 and
8.6 percent in 2006."
The RSMR, which takes into account the
differences in the types of patients across
hospitals and is currently being used by the
Centers for Medicare and Medicaid Services
(CMS) to profile hospital performance,
decreased from 18.8 percent in 1995 to 15.8
percent in 2006, and a reduction in
between-hospital differences in mortality
rates was also observed.
"Between 1995 and 2006, the RSMR for
patients admitted with AMI showed a marked
and significant decrease, as did
between-hospital variation.
"Although
the cause of the reduction cannot be
determined with certainty, this finding may
reflect the success of the many individuals
and organizations dedicated to improving
care during this period," the authors
conclude.
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