• Emily M Bucholz, Neel M Butala, Shuangge Ma, Sharon-Lise T Normand, and Harlan M Krumholz.
• From the Department of Medicine, Boston Children's Hospital (E.M.B.), the Department of Internal Medicine, Massachusetts General Hospital (N.M.B.), the Department of Health Care Policy, Harvard Medical School (S.-L.T.N.), and the Department of Biostatistics, Harvard T.H. Chan School of Public Health (S.-L.T.N.) - all in Boston; and the Departments of Biostatistics (S.M.) and Health Policy and Management (H.M.K.), Yale School of Public Health, the Section of Cardiovascular Medicine, Department of Internal Medicine, and Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine (H.M.K.), and Center for Outcomes Research and Evaluation, Yale-New Haven Hospital (H.M.K.) - all in New Haven, CT.
• N. Engl. J. Med. 2016 Oct 6; 375 (14): 1332-1342.

AbstractBackground Thirty-day risk-standardized mortality rates after acute myocardial infarction are commonly used to evaluate and compare hospital performance. However, it is not known whether differences among hospitals in the early survival of patients with acute myocardial infarction are associated with differences in long-term survival. Methods We analyzed data from the Cooperative Cardiovascular Project, a study of Medicare beneficiaries who were hospitalized for acute myocardial infarction between 1994 and 1996 and who had 17 years of follow-up. We grouped hospitals into five strata that were based on case-mix severity. Within each case-mix stratum, we compared life expectancy among patients admitted to high-performing hospitals with life expectancy among patients admitted to low-performing hospitals. Hospital performance was defined by quintiles of 30-day risk-standardized mortality rates. Cox proportional-hazards models were used to calculate life expectancy. Results The study sample included 119,735 patients with acute myocardial infarction who were admitted to 1824 hospitals. Within each case-mix stratum, survival curves of the patients admitted to hospitals in each risk-standardized mortality rate quintile separated within the first 30 days and then remained parallel over 17 years of follow-up. Estimated life expectancy declined as hospital risk-standardized mortality rate quintile increased. On average, patients treated at high-performing hospitals lived between 0.74 and 1.14 years longer, depending on hospital case mix, than patients treated at low-performing hospitals. When 30-day survivors were examined separately, there was no significant difference in unadjusted or adjusted life expectancy across hospital risk-standardized mortality rate quintiles. Conclusions In this study, patients admitted to high-performing hospitals after acute myocardial infarction had longer life expectancies than patients treated in low-performing hospitals. This survival benefit occurred in the first 30 days and persisted over the long term. (Funded by the National Heart, Lung, and Blood Institute and the National Institute of General Medical Sciences Medical Scientist Training Program.).

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