Relationship between annual volume of patients treated by admitting physician and mortality after acute myocardial infarction.

CONTEXT Acute myocardial infarction (AMI) is a common condition that is treated by physicians with varying levels of clinical experience, but whether the level of experience affects outcome remains uncertain. OBJECTIVE To evaluate the relationship between the average annual volume of cases treated by admitting physicians and mortality after AMI. DESIGN, SETTING, AND PATIENTS Retrospective cohort study using linked administrative databases containing patient admission information for 98 194 patients treated by 5374 physicians between April 1, 1992, and March 31, 1998, in Ontario, Canada. MAIN OUTCOME MEASURES Mortality risk rates for 30 days and 1 year post-AMI, adjusted by physician volume and patient, physician, and hospital characteristics. RESULTS The 30-day mortality rate was 13.5% and the 1-year mortality rate was 21.8%. A strong inverse relationship between the average annual volume of AMI cases treated by the admitting physician and mortality after an AMI was observed. The 30-day risk-adjusted mortality rate was 15.3% for physicians who treated 5 or fewer AMI cases per year (lowest quartile) compared with 11.8% for physicians who treated more than 24 AMI cases annually (highest quartile; P<.001). The 1-year risk-adjusted mortality rate was 24.2% for physicians who treated 5 or fewer AMI cases per year (lowest quartile) compared with 19.6% for physicians who treated more than 24 AMI cases annually (highest quartile; P<.001). CONCLUSION Patients with AMI who are treated by high-volume admitting physicians are more likely to survive at 30 days and 1 year.

[1]  J V Tu,et al.  Development and validation of the Ontario acute myocardial infarction mortality prediction rules. , 2001, Journal of the American College of Cardiology.

[2]  S. Soumerai,et al.  Association of Physician and Hospital Volume With Use of Aspirin and Reperfusion Therapy in Acute Myocardial Infarction , 2000, Medical care.

[3]  P. Austin,et al.  Temporal changes in the outcomes of acute myocardial infarction in Ontario, 1992-1996. , 1999, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[4]  P. Austin,et al.  Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. , 1999, The New England journal of medicine.

[5]  N. Powe,et al.  The association between hospital volume and survival after acute myocardial infarction in elderly patients. , 1999, The New England journal of medicine.

[6]  Robert R. Corrato,et al.  Generalist versus specialist care for acute myocardial infarction. , 1999, The American journal of cardiology.

[7]  R. Califf,et al.  1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). , 1996, Journal of the American College of Cardiology.

[8]  J. Ivanov CABG risk model. , 1998, The Annals of thoracic surgery.

[9]  Harvey Goldstein,et al.  A user's guide to MLwiN, Version 1.0 , 1998 .

[10]  E. DeLong,et al.  Relationship between physician and hospital coronary angioplasty volume and outcome in elderly patients. , 1997, Circulation.

[11]  Marciniak Ta Outcome of acute myocardial infarction according to the specialty of the admitting physician. , 1997 .

[12]  E L Hannan,et al.  Coronary angioplasty volume-outcome relationships for hospitals and cardiologists. , 1997, JAMA.

[13]  R. Califf,et al.  Outcome of acute myocardial infarction according to the specialty of the admitting physician. , 1996, The New England journal of medicine.

[14]  Richard P. Lewis,et al.  ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). , 1996, Journal of the American College of Cardiology.

[15]  E. Hannan,et al.  The decline in coronary artery bypass graft surgery mortality in New York State. The role of surgeon volume. , 1995, JAMA.

[16]  E. DeLong,et al.  Discordance of Databases Designed for Claims Payment versus Clinical Information Systems: Implications for Outcomes Research , 1993, Annals of Internal Medicine.

[17]  A. Dobson,et al.  Secondary prevention after acute myocardial infarction. , 1993, The American journal of cardiology.

[18]  J. Kirklin ACC/AHA guidelines and indications for coronary artery bypass graft surgery. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Coronary Artery Bypass Graft Surgery). , 1991, Circulation.

[19]  D. Hosmer,et al.  Applied Logistic Regression , 1991 .

[20]  D. Rubin,et al.  Reducing Bias in Observational Studies Using Subclassification on the Propensity Score , 1984 .

[21]  J. Hanley,et al.  The meaning and use of the area under a receiver operating characteristic (ROC) curve. , 1982, Radiology.

[22]  P. Loy International Classification of Diseases--9th revision. , 1978, Medical record and health care information journal.