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(Circulation. 2007;116:2280-2287.)
© 2007 American Heart Association, Inc.

Health Services and Outcomes Research

Acute Myocardial Infarction and Congestive Heart Failure Outcomes at Specialty Cardiac Hospitals

Brahmajee K. Nallamothu, MD, MPH; Yongfei Wang, MS; Peter Cram, MD, MBA; John D. Birkmeyer, MD; Joseph S. Ross, MD, MHS; Sharon-Lise T. Normand, PhD; Harlan M. Krumholz, MD, SM

From Health Services Research and Development Center of Excellence, Ann Arbor VA Medical Center, and Department of Internal Medicine, University of Michigan Medical School (B.K.N.), Ann Arbor, Mich; Department of Medicine (Y.W., H.M.K.) and Section of Health Policy and Administration (H.M.K.), Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn; Department of Medicine, University of Iowa (P.C.), Iowa City, Iowa; Department of Surgery, University of Michigan (J.D.B.), Ann Arbor, Mich; Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY and HSR&D Targeted Research Enhancement Program and the Geriatrics Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, NY (J.S.R.); Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health (S.-L.T.N.), Boston, Mass; and Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine and the Yale-New Haven Hospital Center for Outcomes Research and Evaluation (H.M.K.), New Haven, Conn.

Correspondence to Dr Nallamothu, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0366. E-mail bnallamo{at}umich.edu

Received April 20, 2007; accepted August 28, 2007.

Background— Outcomes of patients with acute myocardial infarction (AMI) and congestive heart failure (CHF) at specialty cardiac hospitals are uncertain.

Methods and Results— From 2003 Medicare data, we used hierarchical regression to calculate 30-day standardized mortality ratios and risk-standardized mortality rates for AMI and CHF at 16 cardiac and 121 peer general hospitals in 15 healthcare markets. We then compared cardiac and general hospitals by determining (1) the proportion of facilities with statistically higher, no different, or lower than expected mortality based on 95% interval estimates of standardized mortality ratios and (2) differences in risk-standardized mortality rates between the types of facilities after stratification within healthcare markets. We identified 1912 patients with AMI and 1275 patients with CHF at cardiac hospitals and 13 158 patients with AMI and 18 295 patients with CHF at general hospitals. Patients at cardiac hospitals were younger, were more likely to be male, and had a much lower prevalence of noncardiovascular diseases. After adjustment for patient differences, standardized mortality ratios were significantly better than expected for 4 (25%) and 5 (31%) cardiac hospitals for AMI and CHF, respectively, compared with 5 (4%) and 6 (5%) general hospitals. Risk-standardized mortality rates were modestly lower at cardiac hospitals (15.0% versus 16.2% for AMI, P<0.001, and 10.7% versus 11.3% for CHF, P<0.01).

Conclusions— Patients with AMI and CHF at cardiac hospitals differ considerably from those at peer general hospitals. Although outcomes were modestly better at cardiac hospitals, substantial variation was noted across individual facilities.

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