• Kumar Dharmarajan, Robert L McNamara, Yongfei Wang, Frederick A Masoudi, Joseph S Ross, Erica E Spatz, Nihar R Desai, James A de Lemos, Gregg C Fonarow, Paul A Heidenreich, Deepak L Bhatt, Susannah M Bernheim, Lara E Slattery, Yosef M Khan, and Jeptha P Curtis.
• From Clover Health, Jersey City, New Jersey; Center for Outcomes Research & Evaluation, Yale New Haven Health, and Yale School of Medicine, New Haven, Connecticut; University of Colorado Anschutz Medical Campus, Denver, Colorado; University of Texas Southwestern Medical Center and American Heart Association, Dallas, Texas; Ronald Reagan UCLA Medical Center, Los Angeles, California; Stanford University Medical Center, Palo Alto, California; Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and American College of Cardiology, Washington, DC.
• Ann. Intern. Med. 2017 Oct 17; 167 (8): 555-564.

BackgroundPublicly reported hospital risk-standardized mortality rates (RSMRs) for acute myocardial infarction (AMI) are calculated for Medicare beneficiaries. Outcomes for older patients with AMI may not reflect general outcomes.ObjectiveTo examine the relationship between hospital 30-day RSMRs for older patients (aged ≥65 years) and those for younger patients (aged 18 to 64 years) and all patients (aged ≥18 years) with AMI.DesignRetrospective cohort study.Setting986 hospitals in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry-Get With the Guidelines.ParticipantsAdults hospitalized for AMI from 1 October 2010 to 30 September 2014.MeasurementsHospital 30-day RSMRs were calculated for older, younger, and all patients using an electronic health record measure of AMI mortality endorsed by the National Quality Forum. Hospitals were ranked by their 30-day RSMRs for these 3 age groups, and agreement in rankings was plotted. The correlation in hospital AMI achievement scores for each age group was also calculated using the Hospital Value-Based Purchasing (HVBP) Program method computed with the electronic health record measure.Results267 763 and 276 031 AMI hospitalizations among older and younger patients, respectively, were identified. Median hospital 30-day RSMRs were 9.4%, 3.0%, and 6.2% for older, younger, and all patients, respectively. Most top- and bottom-performing hospitals for older patients were neither top nor bottom performers for younger patients. In contrast, most top and bottom performers for older patients were also top and bottom performers for all patients. Similarly, HVBP achievement scores for older patients correlated weakly with those for younger patients (R = 0.30) and strongly with those for all patients (R = 0.92).LimitationMinority of U.S. hospitals.ConclusionHospital mortality rankings for older patients with AMI inconsistently reflect rankings for younger patients. Incorporation of younger patients into assessment of hospital outcomes would permit further examination of the presence and effect of age-related quality differences.Primary Funding SourceAmerican College of Cardiology.

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