MI Survival Rates Extended at High-Performing Hospitals

Myocardial infarction (MI) patients admitted to health care institutions demonstrating favorable 30-day risk-standardized mortality rates may also have longer life expectancies than those treated at low-performing hospitals, according to a recent analysis.

“Previous studies have similarly shown that the survival benefits associated with individual therapies occur largely in the first 30 days and then persist over time,” Emily M Bucholz, MD, PhD, MPH, of the department of medicine at Boston Children’s Hospital, and colleagues wrote. “Our study extends these findings to short-term hospital-outcome measures and shows that the early survival advantage achieved by high-performing hospitals is durable.”

To investigate a relationship between hospitals’ short- and long-term survival rates, Dr Bucholz and colleagues reviewed 17 years of follow-up data collected from 119,735 MI patients throughout the Cooperative Cardiovascular Project. After grouping the 1824 hospitals attended by these patients into five case-mix severity-based strata, the researchers compared the life expectancies of patients admitted to high-performing hospitals (high 30-day survival rates) to those of patients who received care at low-performing hospitals (low 30-day survival).

Dr Bucholz and colleagues found a decline in patients’ estimated life expectancy directly associated with increased hospital risk-standardized mortality rates. Patients treated at high-performing hospitals lived 0.74 to 1.14 years longer than those admitted to low-performing hospitals throughout all case-mix strata, suggesting that this relationship is independent of hospital case mix. Survival trends diverged during the first 30 days after hospitalization, the researchers wrote, and remained parallel throughout 17 years of follow-up. Further, limiting analysis to patients who survived the first 30 days revealed no significant differences in adjusted or unadjusted life expectancy between high- and low-performing hospitals, indicating that the association between early hospital performance and long-term survival may be due to quality differences and not residual confounding.

“The survival advantage for patients treated at high-performing hospitals arose from differences in survival during the first 30 days after hospitalization and then persisted during the remainder of follow-up,” Dr Bucholz and colleagues wrote. “Our results suggest that investing in initiatives to improve short-term hospital performance may also improve patient outcomes over the long term.” —Dave Muoio