Further information: Medical Treatment of Unstable Angina, Acute Non–ST-Elevation Myocardial Infarction, and Coronary Artery Spasm (see p937) and Treatment of Acute ST-Elevation Myocardial Infarction (see p963) from Cardiovascular Medicine, 3rd Edn*

Investigators conducted this observational study [1] to evaluate whether efforts over the past 20 years to improve outcomes for patients hospitalized with acute myocardial infarction (AMI) had also resulted in a reduction in hospitals’ Risk-Standard Mortality Rates (RSMR), thereby showing hospitals’ improvements in short-term mortality rates for AMI and in between-hospital variation in short-term mortality rates. Within the period studied, the emphasis had been on achieving improved outcomes for patients who had been hospitalized for AMI. Clinical practice guidelines emphasizing the importance in the use of evidence-based medicine were published by the American Heart Association and the American College of Cardiology, and as a result of such emphasis, and as determined by evaluating data obtained from Medicare patients discharged from hospitals between January 1995 and December 2006, the number of deaths was shown to decrease in MI patients. However, whether the same favorable results had been achieved by hospitals to improve short-term mortality rates for AMI and in between-hospital variation in short-term mortality rates was not known. The results of examining the data obtained from the Medicare patients showed that the reduction in hospital-specific RSMRs was from 18.8% in 1995 to 15.8% in 2006 (odds ratio, 0.76; 95% confidence interval [CI], 0.75–0.77). Also from 1995–2006, reduction in between-hospital heterogeneity in the RSMRs was apparent. The coefficient of variation decreased in 1995 from 11.2 % to 10.8%, the interquartile range from 2.8% to 2.1%, and the between-hospital variance from 4.4% to 2.9%.

[1] Krumholz, HM, Wang Y, Chen J, et al. Reduction in acute myocardial infarction mortality in the United States. JAMA 2009;302:767-73

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