Health Care Provision and Volume-Outcome Relationship for Acute Myocardial Infarction: Long-Term Analysis of German Nationwide Hospital Discharge Data 2005-2015

Abstract

Studies on acute myocardial infarction have reported that higher hospital volume is associated with better outcomes. In this context, changes of acute hospital care for myocardial infarction and of the volume-outcome relationship were analysed. The aim of this study was to assess developments of hospital care in order to derive approaches for improving care for acute myocardial infarction in German hospitals. Inpatient cases of acute myocardial infarction in the first admitting hospital were identified from the complete national hospital discharge data (DRG statistics) 2005-2015. These cases were assigned to quintiles according to the annual myocardial infarction case volume of the treating hospital. From 2005 to 2015, there was an increase in the proportion of patients with myocardial infarction treated with a coronary intervention. In-hospital mortality in first treating hospitals declined from 12.1 to 8.7%. In all the years of observation, mortality was lower in higher volume hospitals quintiles than in the very-low volume quintile. In 2015, the risk of in-hospital death in hospitals with medium, high, or very high volume was 20% lower (adjusted OR 0.8 [95% KI 0.7-0.9] respectively), compared to very-low volume hospitals. More than 40% of very-low volume hospitals were located in urban areas. Hospital care for acute myocardial infarction in Germany can be improved further, if patients with heart attack symptoms were primarily allocated to hospitals with high volumes. For reasons of medical quality and economic efficiency, such a targeted referral is essential particularly in urban regions.