Abstract 330: Hospital-Level Variation in One-Year Mortality and Angina Following Myocardial Infarction is Not Explained by In-Hospital Quality of Care in the TRIUMPH Registry

Abstract

Background: Studies demonstrating variation in hospital quality of care using longitudinal outcomes have been limited in the amount of clinical data used to stratify patients’ risks and have not examined health status outcomes. We sought to describe hospital-level variation in risk-adjusted health status and mortality in the year following myocardial infarction (MI) and describe the extent to which hospital quality of care explains this variation. Methods: 4,316 patients from the TRIUMPH registry, a prospective cohort study of MI patients at 24 hospitals, were included for analysis. Using hierarchical models, we described the hospital-level variation in angina (yes/no) and 1-year mortality rates. We then added hospital quality of care measures for MI applicable to the time period studied (ASA and beta blockers within 24 hours of arrival and at discharge, ACE/ARB at discharge, thrombolytics within 30 minutes, PCI within 90 minutes, and smoking cessation instructions at discharge) to these models to determine if hospital variation in one-year mortality and angina were explained by index MI quality of care. Results: The mortality rate at one year was 6.2% and the incidence of angina at one year was 23.0%. Unadjusted hospital-level 1-year mortality ranged from 0% to 10.8% and unadjusted presence of angina ranged from 9.3% to 66.7%. Statistically significant hospital-level variation in one-year mortality and angina was observed, with risk-adjusted mortality rates ranging from 5% to 8.3% (p<0.0001) and risk-adjusted angina rates ranging from 17.6% to 31.9% (p<0.0001). In-hospital quality of care measures did not attenuate hospital-level variation in mortality or angina (Figure 1). Conclusions: Hospital-level variation in 1-year mortality and angina was observed among the 24 hospitals participating in this MI registry. However, this variation was not explained by in-hospital MI performance measures. Future studies should assess care delivery factors that impact longitudinal outcomes following MI.