DCRI study looks at whether patients who recieve guideline-recommended therapies at academic medical centers fare better in the long termMay 12, 2014
Patients with non-ST-segment myocardial infarction (NSTEMI) who are treated at academic medical centers are more likely to receive guideline-recommended therapies and have modestly better 30-day outcomes compared with NTEMI patients at nonacademic centers, according to a recent DCRI-led study, but these differences do not persist out to 1 year.
The study—by the DCRI’s Emily O'Brien, PhD (pictured); Sumeet Subherwal, MD, MBA; Matthew Roe, MD, MHS; DaJuanicia Holmes, MS; Laine Thomas, PhD; Karen Alexander, MD; Tracy Wang, MD, MHS, MSc; and Eric Peterson, MD, MPH—appears in the current issue of the American Heart Journal.
Earlier studies have found that academic hospitals provide more consistent use of guideline-recommended therapies for NSTEMI patients compared with nonacademic centers, but it has been unclear whether these care differences translate into longer-term outcome differences. For this study, O’Brien and her colleagues obtained data from the CRUSADE Registry, a voluntary quality improvement initiative that enrolled cardiac patients from January of 2001 through December of 2006. The data were then linked to Centers for Medicare and Medicaid Services claims.
The researchers identified 12,194 older NSTEMI patients treated at 103 academic centers and 28,335 patients treated at 302 nonacademic centers across the United States from 2003 through 2006. They then compared 30-day and 1-year all-cause mortality rates within each group. After controlling for clinical characteristics and hospital performance, the researchers found that NSTEMI patients treated at academic hospitals had a modestly lower 30-day risk-adjusted mortality (despite a greater prevalence of comorbidities), displayed larger variation in hospital-level adherence to guideline-recommended therapies, and had less variation in those therapies.
The differences in 30-day mortality rates between the two groups after adjustment for hospital-level adherence to these therapies suggest that greater hospital adherence to evidence-based therapies could explain the lower risk of death seen among patients cared for at academic hospitals. Despite this possibility, the differences in mortality between the groups did not persist at 1 year, which may reflect other factors involved in patient care during longer-term follow-up.
Further efforts are needed to identify system methods for improving adherence to cost-effective evidence-based therapies, the researchers concluded.