Use of Medical Resources and Quality of Life after Acute Myocardial Infarction in Canada and the United States

Mark, Daniel B.; Cd, Naylor; Hlatky, Mark A.; Califf, RM; Topol, Eric J.; Granger, Claire; Jd, Knight; Cl, Nelson; Lee, KL; Ne, Clapp-Channing

doi:10.1056/nejm199410273311706

Cited by 305 publications

(136 citation statements)

References 11 publications

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“…9 Despite substantial differences in the use of cardiac procedures after AMI, there were no differences in symptoms or functional status. In contrast, a study by Mark and associates 5 comparing Canadian and US patients enrolled in a substudy of the GUSTO-1 trial found that Canadians underwent fewer procedures and had worse functional status 1 year after discharge.…”

Section: Discussionmentioning

confidence: 74%

“…Because hospital charges are not a reliable measure of resource consumption, 5,18 hospital costs were determined from each patient's detailed hospital charge record and each hospital's departmental Medicare cost-to-charge ratios derived from each hospital's annual Medicare Cost Report 5 as described in a previous report. 19 All costs were converted to 1996 dollars at a discount rate of 5%.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12] Studies have shown that the presence of an on-site cardiac catheterization facility in the admitting hospital is an important predictor of cardiac catheterization after an AMI. 8,10,13 Investigators from the Myocardial Infarction Triage and Intervention Project (MITI) reported that patients admitted to a hospital with an on-site cardiac catheterization facility had a 3-fold increase in the likelihood of undergoing cardiac catheterization, 7 exceeding the importance of any other clinical factor, including recurrent chest pain and infarct extension.…”

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confidence: 99%

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Admission to Hospitals With On-Site Cardiac Catheterization Facilities

et al. 1998

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Background-Admission to a hospital with a capability for cardiac procedures is associated with a higher likelihood of referral for a cardiac procedure but not with a better short-term clinical outcome. Whether there are differences in long-term mortality and resource consumption is not clear. We sought to determine whether elderly Medicare patients with acute myocardial infarction admitted to hospitals with on-site cardiac catheterization facilities have lower long-term hospital costs and better outcomes than patients admitted to hospitals without such facilities. Methods and Results-As part of the Cooperative Cardiovascular Project pilot in Connecticut, we conducted a retrospective cohort study using data from medical charts and administrative files. The study sample included 2521 patients with acute myocardial infarction covered by Medicare from 1992 to 1993. The cardiac catheterization rate was higher in the hospitals with facilities (38.6% versus 26.9%; PϽ0.001), but the revascularization rate was similar (20.5% versus 19.5%) during the initial episode of care and at 3 years (29.7% versus 29.7%). Mortality rates were similar for patients admitted to the 2 types of hospitals at 30 days (OR, 1.08; 95% CI, 0.83 to 1.42) and at 3 years (OR, 1.02; 95% CI, 0.83 to 1.26). The adjusted readmission rates were significantly lower among patients admitted to hospitals with cardiac catheterization facilities (OR, 0.76; 95% CI, 0.61 to 0.94). However, the overall mean days in the hospital for the 3 years after admission was 25.9 for patients admitted to hospitals with facilities and 24.6 for the other patients (Pϭ0.234). Adjusting for baseline patient characteristics, there was no significant difference in the 3-year costs between patients admitted to the 2 types of hospitals. Conclusions-With higher rates of cardiac catheterization and lower readmission rates, patients admitted to hospitals with on-site cardiac catheterization facilities did not have significantly different hospital costs compared with patients admitted to hospitals without these facilities. There was also no significant difference in short-or long-term mortality rates.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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Admission to Hospitals With On-Site Cardiac Catheterization Facilities

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“…This survival benefit was substantially greater than at 1 year. 12 Greater use of coronary angioplasty and CABG surgery during initial AMI hospitalizations in the United States explained all of the difference statistically in long-term survival between US and Canadian patients.…”

Section: Article Pp 374 and 380mentioning

confidence: 96%

Rising Rates of Cardiac Procedures in the United States and Canada

Ayanian

2006

Circulation

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“…Another line of research compares medical treatments in different countries (e.g., Rouleau et al 1993;Mark et al 1994;McGlynn et al 1994;Tu et al 1997), different areas of the country (e.g., Wennberg et al 1987), and more and less intensive hospitals (e.g., Garber, Fuchs, and Silverman, 1984) to judge the value of more intensive medical care. Uniformly, these studies find a substantial amount of wasted resources.…”

Section: The Marginal Value Of Medical Carementioning

confidence: 99%

Your Money and Your Life: The Value of Health and What Affects It

Cutler¹,

Richardson²

1999

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Use of Medical Resources and Quality of Life after Acute Myocardial Infarction in Canada and the United States

Cited by 305 publications

References 11 publications

Admission to Hospitals With On-Site Cardiac Catheterization Facilities

Admission to Hospitals With On-Site Cardiac Catheterization Facilities

Rising Rates of Cardiac Procedures in the United States and Canada

Your Money and Your Life: The Value of Health and What Affects It

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