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Circulation
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Published Online
on October 20, 2008

Circulation. 2008
Published online before print October 20, 2008, doi: 10.1161/CIRCULATIONAHA.108.792713
A more recent version of this article appeared on November 4, 2008
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Submitted on May 16, 2008
Accepted on September 8, 2008

Patient Satisfaction and Its Relationship With Quality and Outcomes of Care After Acute Myocardial Infarction

Douglas S. Lee MD, PhD, Jack V. Tu MD, PhD, Alice Chong BSc, and David A. Alter MD, PhD*

From the Institute for Clinical Evaluative Sciences (D.S.L., J.V.T., A.C., D.A.A.), Division of Cardiology, University Health Network (D.S.L.), Division of Cardiology, Sunnybrook Health Sciences Centre (J.V.T.), and Division of Cardiology, St Michael's Hospital (D.A.A.), University of Toronto, Toronto, Canada.

* To whom correspondence should be addressed. E-mail: david.alter{at}ices.on.ca.

Background—Patient satisfaction is a widely used measurement for the evaluation of medical care. We examined the extent to which quality of care received after acute myocardial infarction predicted subsequent patient satisfaction with care and whether patient satisfaction itself was associated with long-term survival after acute myocardial infarction.

Methods and Results—In a longitudinal cohort of acute myocardial infarction, we examined the associations of patient-reported satisfaction with care with clinical characteristics, physical and psychological function measures, quality indicators of myocardial infarction care, and outcomes. Among 1933 eligible patients (mean age 62.9±12.8 years, 70.5% men), 1866 survey respondents were analyzed. Of the study cohort, 1711 (91.7%) reported that they were satisfied with their overall care. Patients who reported satisfaction with care were older (mean age 63.1±12.7 versus 60.1±13.3 years, P=0.005), had improved physical function, and were less likely to be depressed. Better physical function, measured by the Specific Activity Scale, predicted higher satisfaction, with an OR of 1.75 (95% CI 1.17 to 2.68, P=0.008) for intermediate versus poor function and 2.96 (1.39 to 7.34, P=0.009) for high versus poor function, after adjustment for age, sex, income tertile, and ethnicity. Depression was the major predictor of dissatisfaction with overall care, with an OR of 0.44 (95% CI 0.29 to 0.67, P<0.001). Quality indicators for myocardial infarction care and clinical outcomes were not associated with patient satisfaction.

Conclusions—Satisfaction with care was more likely in patients who were older, in those without depression, and in those with better functional capacity, but it was not associated with the quality of myocardial infarction care or survival.


Key words: myocardial infarction • patient satisfaction • health status • quality of health care • outcomes


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Clinical Summaries
Circulation 2008 118: 1911-1912. [Extract] [Full Text]