Abstract 19066: Quantifying the Years of Life Gained From Myocardial Infarction Admission Process-of-Care Measures
Background: Studies evaluating process of care measures for acute myocardial infarction (AMI) have generally demonstrated improved 30-day survival for patients receiving these therapies; however, almost no studies have followed patients beyond 1 year. As a result, there is considerable uncertainty as to whether the early survival benefits persist over the long-term.
Methods: We analyzed data from the Cooperative Cardiovascular Project, a study of Medicare beneficiaries hospitalized for AMI between 1994 and 1995, to examine the relationship between 5 AMI admission measures (aspirin, beta-blockers, acute reperfusion therapy, time to percutaneous coronary intervention (PCI) ≤90 minutes, and time to fibrinolysis ≤30 min) and life expectancy after AMI. Patient eligibility for each measure was determined using AHA/ACC guidelines, and vital status over 17 years of follow-up was ascertained through the Medicare Denominator files. Cox proportional hazards regression with extrapolation using exponential models was used to calculate life expectancy after AMI.
Results: Our study cohort consisted of 147,429 patients who were eligible for at least one measure. Survival curves for recipients and non-recipients of each core measure separated within the first year and remained distinct over the remainder of follow-up. This pattern was consistent across all five therapies and resulted in significantly longer life expectancies for patients receiving these therapies (Table 1). Differences in life expectancy between recipients and non-recipients decreased but remained significant after adjustment for patient and hospital characteristics.
Conclusions: Receipt of 5 AMI admission therapies was associated with significant gains in life expectancy after AMI, lending further support for AMI process of care measures, which can be delivered rapidly at the time of hospitalization.
Author Disclosures: E.M. Bucholz: Research Grant; Significant; NIGMS Medical Scientist Training Program grant T32GM07205. N.M. Butala: None. S.T. Normand: None. H.M. Krumholz: Research Grant; Significant; Medtronic, Johnson and Johnson. Consultant/Advisory Board; Significant; United Health Care.
- © 2014 by American Heart Association, Inc.