Abstract 5334: Association Between Hospital Process Performance and 1-Year Post-discharge Mortality in Patients With Non-ST-elevation Myocardial Infarction: Results From 36,262 Patients
Background: While hospitals’ adherence to performance measures for evidence-based NSTEMI care has been associated with better in-hospital outcomes, its association with long-term mortality is unknown.
Methods: Clinical data from CRUSADE were matched to Medicare claims, creating a longitudinal record of outcomes for patients aged >=65 years. Cox proportional hazard modeling was used to examine the association between 1-year post-discharge mortality and hospital composite adherence to 9 Class I ACC/AHA guideline therapies (antiplatelet, beta-blocker, any heparin, and GP IIB/IIIA within 24 hours; antiplatelet, beta-blocker, clopidogrel, ACEI/ARB, and lipid-lowering agent at discharge).
Results: Between February 19, 2003, and December 31, 2006, 36,262 NSTEMI patients treated at 268 CRUSADE hospitals were linked to Medicare data. The median hospital composite performance adherence score was 81% and varied widely (lowest to highest quartile: 73%, 79%, 83%, and 88%). Greater composite performance adherence was strongly associated with reduction in 1-year mortality. The observed 1-year mortality rate was 21%. Unadjusted mortality rates were 24%, 22%, 19%, and 19% in the lowest to highest hospital adherence score quartiles. This association persisted after adjusting for baseline clinical factors and additionally for revascularization (p<0.001 between highest and lowest hospital adherence score quartiles for all hazard ratios) (Figure⇓).
Conclusion: Hospital adherence to ACC/AHA AMI guideline therapies is strongly associated with improved long-term mortality, further supporting the use of these metrics for measuring and improving AMI. care.