INTERNATIONAL RESEARCH & OPINION Is swvival after acute MI linked to hospital volume? In the initial hospital care of elderly patients with acute myocardial infarction (MI), the patient's chance of survival is associated with the number of patients with MI that the hospital treats (hospital volume), report researchers from the US.! In this retrospective study, * survival rates were anal ysed in a cohort of 98 898 patients aged 65 years who were admitted to hospital from home with acute MI. The hazard ratios for 30-day survival for patients treated in hospitals with volumes in the fIrst, second and third quartiles, compared with those in the fourth quartile, were 1.17 (95% CI 1.09-1.26; P < 0.001), 1.07 (1.01-1.13; P = 0.02) and 1.05 (0.99-1.1; P = 0.11), respectively.** The researchers say that there was 'virtually no change in the mortality differential' after adjusting for: clinical factors; the availability of angiography, angioplasty and bypass surgery at the hospital; whether the attending physician's specialty was cardiology, internal medicine or family practice; and whether patients lived in rural, urban or metropolitan areas. They add that about one-third of the survival benefIt seen in high-volume hospitals was attributable to the use of aspirin, thrombolytics, ACE inhibitors and revascularisation. However, the researchers could not identify a predominant mechanism for the survival advantage. Dr Edward Hannan from the University of Albany School of Public Health, New York. US, says that while hospital volume may enable variations in the outcomes of care to be identifIed, 'it should not be considered the final determinant of quality', but 'merely a proxy for more precise measures of quality' . 2 * The study used data from the Cooperative Cardiovascular Project. ** The first quartile had the lowest hospital volume and the fourth quartile had the highest hospital volume. 1. Thiemann DR. et aI. 1be association between hospital volume and survival after acute myocardial infarction in elderly patients. New England Journal of Medicine 340: 1640-1648. 27 May 1999 2. Hannan EL. The relation between volume and outcome in health care. New England Journal of Medicine 340: 1677-1679.27 May 1999 100762&4' 1173-5503I9910216-00091$01.rxf> Adl.lntematlonal Limited 1l1li9. All rlght8 rn.vecI PhannacoEconomics & OuIr:omes News 12 Jun 1999 No. 216 9

Is survival after acute MI linked to hospital volume?

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Page 1: Is survival after acute MI linked to hospital volume?

INTERNATIONAL RESEARCH & OPINION

Is swvival after acute MI linked to hospital volume?

In the initial hospital care of elderly patients with acute myocardial infarction (MI), the patient's chance of survival is associated with the number of patients with MI that the hospital treats (hospital volume), report researchers from the US.!

In this retrospective study, * survival rates were anal ysed in a cohort of 98 898 patients aged ~ 65 years who were admitted to hospital from home with acute MI.

The hazard ratios for 30-day survival for patients treated in hospitals with volumes in the fIrst, second and third quartiles, compared with those in the fourth quartile, were 1.17 (95% CI 1.09-1.26; P < 0.001), 1.07 (1.01-1.13; P = 0.02) and 1.05 (0.99-1.1; P = 0.11), respectively.**

The researchers say that there was 'virtually no change in the mortality differential' after adjusting for: clinical factors; the availability of angiography, angioplasty and bypass surgery at the hospital; whether the attending physician's specialty was cardiology, internal medicine or family practice; and whether patients lived in rural, urban or metropolitan areas.

They add that about one-third of the survival benefIt seen in high-volume hospitals was attributable to the use of aspirin, thrombolytics, ~-blockers, ACE inhibitors and revascularisation. However, the researchers could not identify a predominant mechanism for the survival advantage.

Dr Edward Hannan from the University of Albany School of Public Health, New York. US, says that while hospital volume may enable variations in the outcomes of care to be identifIed, 'it should not be considered the final determinant of quality', but 'merely a proxy for more precise measures of quality' .2

* The study used data from the Cooperative Cardiovascular Project. * * The first quartile had the lowest hospital volume and the fourth quartile had the highest hospital volume. 1. Thiemann DR. et aI. 1be association between hospital volume and survival after acute myocardial infarction in elderly patients. New England Journal of Medicine 340: 1640-1648. 27 May 1999 2. Hannan EL. The relation between volume and outcome in health care. New England Journal of Medicine 340: 1677-1679.27 May 1999 100762&4'

1173-5503I9910216-00091$01.rxf> Adl.lntematlonal Limited 1l1li9. All rlght8 rn.vecI PhannacoEconomics & OuIr:omes News 12 Jun 1999 No. 216