The effect of high-risk ST elevation myocardial infarction transfer patients on risk-adjusted in-hospital mortality: A report from the American Heart Association Mission: Lifeline program

Michael C. Kontos, Tracy Y. Wang, Anita Y. Chen, Eric R. Bates, Harold L. Dauerman, Timothy D. Henry, Steven V. Manoukian, Matthew T. Roe, Robert E Suter, Laine Thomas, William J. French

Research output: Contribution to journalArticle

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Abstract

Hospital mortality is an important quality measure for acute myocardial infarction care. There is a concern that despite risk adjustment, percutaneous coronary intervention hospitals accepting a greater volume of high-risk ST elevation myocardial infarction (STEMI) transfer patients may have their reported mortality rates adversely affected. Methods The STEMI patients in the National Cardiovascular Data RegistryAcute Coronary Treatment Intervention Outcomes Network Registry—Get With the Guidelines from April 2011 to December 2013 were included. High-risk STEMI was defined as having either cardiogenic shock or cardiac arrest on first medical contact. Receiving hospitals were divided into tertiles based on the ratio of high-risk STEMI transfer patients to the total number of STEMI patients treated at each hospital. Using the Action Coronary Treatment Intervention Outcomes Network Registry—Get With the Guidelines in-hospital mortality risk model, we calculated the difference in risk-standardized in-hospital mortality before and after excluding high-risk STEMI transfers in each tertile. Results Among 119,680 STEMI patients treated at 539 receiving hospitals, 37,028 (31%) were transfer patients, of whom 4,500 (12%) were highrisk. The proportion of high-risk STEMI transfer patients ranged from 0% to 12% across hospitals. Unadjusted mortality rates in the low-, middle-, and high-tertile hospitals were 6.0%, 6.0%, and 5.9% among all STEMI patients and 6.0%, 5.5%, and 4.6% after excluding high-risk STEMI transfers. However, risk-standardized hospital mortality rates were not significantly changed after excluding high-risk STEMI transfer patients in any of the 3 hospital tertiles (low, −0.04%; middle, −0.05%; and high, 0.03%). Conclusions Risk-adjusted in-hospital mortality rates were not adversely affected in STEMI-receiving hospitals who accepted more high-risk STEMI transfer patients when a clinical mortality risk model was used for risk adjustment.

Original languageEnglish (US)
Pages (from-to)74-81
Number of pages8
JournalAmerican Heart Journal
Volume180
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

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Patient Transfer
Hospital Mortality
Mortality
Risk Adjustment
ST Elevation Myocardial Infarction
Guidelines
Cardiogenic Shock
Percutaneous Coronary Intervention
Heart Arrest

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The effect of high-risk ST elevation myocardial infarction transfer patients on risk-adjusted in-hospital mortality : A report from the American Heart Association Mission: Lifeline program. / Kontos, Michael C.; Wang, Tracy Y.; Chen, Anita Y.; Bates, Eric R.; Dauerman, Harold L.; Henry, Timothy D.; Manoukian, Steven V.; Roe, Matthew T.; Suter, Robert E; Thomas, Laine; French, William J.

In: American Heart Journal, Vol. 180, 01.10.2016, p. 74-81.

Research output: Contribution to journalArticle

Kontos, Michael C. ; Wang, Tracy Y. ; Chen, Anita Y. ; Bates, Eric R. ; Dauerman, Harold L. ; Henry, Timothy D. ; Manoukian, Steven V. ; Roe, Matthew T. ; Suter, Robert E ; Thomas, Laine ; French, William J. / The effect of high-risk ST elevation myocardial infarction transfer patients on risk-adjusted in-hospital mortality : A report from the American Heart Association Mission: Lifeline program. In: American Heart Journal. 2016 ; Vol. 180. pp. 74-81.
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abstract = "Hospital mortality is an important quality measure for acute myocardial infarction care. There is a concern that despite risk adjustment, percutaneous coronary intervention hospitals accepting a greater volume of high-risk ST elevation myocardial infarction (STEMI) transfer patients may have their reported mortality rates adversely affected. Methods The STEMI patients in the National Cardiovascular Data RegistryAcute Coronary Treatment Intervention Outcomes Network Registry—Get With the Guidelines from April 2011 to December 2013 were included. High-risk STEMI was defined as having either cardiogenic shock or cardiac arrest on first medical contact. Receiving hospitals were divided into tertiles based on the ratio of high-risk STEMI transfer patients to the total number of STEMI patients treated at each hospital. Using the Action Coronary Treatment Intervention Outcomes Network Registry—Get With the Guidelines in-hospital mortality risk model, we calculated the difference in risk-standardized in-hospital mortality before and after excluding high-risk STEMI transfers in each tertile. Results Among 119,680 STEMI patients treated at 539 receiving hospitals, 37,028 (31{\%}) were transfer patients, of whom 4,500 (12{\%}) were highrisk. The proportion of high-risk STEMI transfer patients ranged from 0{\%} to 12{\%} across hospitals. Unadjusted mortality rates in the low-, middle-, and high-tertile hospitals were 6.0{\%}, 6.0{\%}, and 5.9{\%} among all STEMI patients and 6.0{\%}, 5.5{\%}, and 4.6{\%} after excluding high-risk STEMI transfers. However, risk-standardized hospital mortality rates were not significantly changed after excluding high-risk STEMI transfer patients in any of the 3 hospital tertiles (low, −0.04{\%}; middle, −0.05{\%}; and high, 0.03{\%}). Conclusions Risk-adjusted in-hospital mortality rates were not adversely affected in STEMI-receiving hospitals who accepted more high-risk STEMI transfer patients when a clinical mortality risk model was used for risk adjustment.",
author = "Kontos, {Michael C.} and Wang, {Tracy Y.} and Chen, {Anita Y.} and Bates, {Eric R.} and Dauerman, {Harold L.} and Henry, {Timothy D.} and Manoukian, {Steven V.} and Roe, {Matthew T.} and Suter, {Robert E} and Laine Thomas and French, {William J.}",
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T2 - A report from the American Heart Association Mission: Lifeline program

AU - Kontos, Michael C.

AU - Wang, Tracy Y.

AU - Chen, Anita Y.

AU - Bates, Eric R.

AU - Dauerman, Harold L.

AU - Henry, Timothy D.

AU - Manoukian, Steven V.

AU - Roe, Matthew T.

AU - Suter, Robert E

AU - Thomas, Laine

AU - French, William J.

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N2 - Hospital mortality is an important quality measure for acute myocardial infarction care. There is a concern that despite risk adjustment, percutaneous coronary intervention hospitals accepting a greater volume of high-risk ST elevation myocardial infarction (STEMI) transfer patients may have their reported mortality rates adversely affected. Methods The STEMI patients in the National Cardiovascular Data RegistryAcute Coronary Treatment Intervention Outcomes Network Registry—Get With the Guidelines from April 2011 to December 2013 were included. High-risk STEMI was defined as having either cardiogenic shock or cardiac arrest on first medical contact. Receiving hospitals were divided into tertiles based on the ratio of high-risk STEMI transfer patients to the total number of STEMI patients treated at each hospital. Using the Action Coronary Treatment Intervention Outcomes Network Registry—Get With the Guidelines in-hospital mortality risk model, we calculated the difference in risk-standardized in-hospital mortality before and after excluding high-risk STEMI transfers in each tertile. Results Among 119,680 STEMI patients treated at 539 receiving hospitals, 37,028 (31%) were transfer patients, of whom 4,500 (12%) were highrisk. The proportion of high-risk STEMI transfer patients ranged from 0% to 12% across hospitals. Unadjusted mortality rates in the low-, middle-, and high-tertile hospitals were 6.0%, 6.0%, and 5.9% among all STEMI patients and 6.0%, 5.5%, and 4.6% after excluding high-risk STEMI transfers. However, risk-standardized hospital mortality rates were not significantly changed after excluding high-risk STEMI transfer patients in any of the 3 hospital tertiles (low, −0.04%; middle, −0.05%; and high, 0.03%). Conclusions Risk-adjusted in-hospital mortality rates were not adversely affected in STEMI-receiving hospitals who accepted more high-risk STEMI transfer patients when a clinical mortality risk model was used for risk adjustment.

AB - Hospital mortality is an important quality measure for acute myocardial infarction care. There is a concern that despite risk adjustment, percutaneous coronary intervention hospitals accepting a greater volume of high-risk ST elevation myocardial infarction (STEMI) transfer patients may have their reported mortality rates adversely affected. Methods The STEMI patients in the National Cardiovascular Data RegistryAcute Coronary Treatment Intervention Outcomes Network Registry—Get With the Guidelines from April 2011 to December 2013 were included. High-risk STEMI was defined as having either cardiogenic shock or cardiac arrest on first medical contact. Receiving hospitals were divided into tertiles based on the ratio of high-risk STEMI transfer patients to the total number of STEMI patients treated at each hospital. Using the Action Coronary Treatment Intervention Outcomes Network Registry—Get With the Guidelines in-hospital mortality risk model, we calculated the difference in risk-standardized in-hospital mortality before and after excluding high-risk STEMI transfers in each tertile. Results Among 119,680 STEMI patients treated at 539 receiving hospitals, 37,028 (31%) were transfer patients, of whom 4,500 (12%) were highrisk. The proportion of high-risk STEMI transfer patients ranged from 0% to 12% across hospitals. Unadjusted mortality rates in the low-, middle-, and high-tertile hospitals were 6.0%, 6.0%, and 5.9% among all STEMI patients and 6.0%, 5.5%, and 4.6% after excluding high-risk STEMI transfers. However, risk-standardized hospital mortality rates were not significantly changed after excluding high-risk STEMI transfer patients in any of the 3 hospital tertiles (low, −0.04%; middle, −0.05%; and high, 0.03%). Conclusions Risk-adjusted in-hospital mortality rates were not adversely affected in STEMI-receiving hospitals who accepted more high-risk STEMI transfer patients when a clinical mortality risk model was used for risk adjustment.

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