Evidence-Based Therapies and Mortality in Patients Hospitalized in December with Acute Myocardial Infarction

4 October 2005 | Volume 143 Issue 7 | Pages 481-485

Background: Previous studies suggest that patients hospitalized with acute myocardial infarction (MI) in December have poor outcomes, and some studies have hypothesized that the cause may be the infrequent use of evidence-based therapies during the December holiday season.

Objective: To compare the care and outcomes of patients with acute MI hospitalized in December and patients hospitalized during other months.

Design: Retrospective analysis of data from the Cooperative Cardiovascular Project.

Setting: Nonfederal, acute care hospitals in the United States.

Patients: 127 959 Medicare beneficiaries hospitalized between January 1994 and February 1996 with confirmed acute MI.

Measurements: Use of aspirin, ß-blockers, and reperfusion therapy (thrombolytic therapy or percutaneous coronary intervention), and 30-day mortality.

Results: When the authors controlled for patient, hospital, and physician characteristics, the use of evidence-based therapies was not significantly lower but 30-day mortality was higher (21.7% vs. 20.1%; adjusted odds ratio, 1.07 [95% CI, 1.02 to 1.12]) among patients hospitalized in December.

Limitations: This was a nonrandomized, observational study. Unmeasured characteristics may have contributed to outcome differences.

Conclusions: Thirty-day mortality rates were higher for Medicare patients hospitalized with acute MI in December than in other months, although the use of evidence-based therapies was not significantly lower.

Editors' Notes Context In the United States, the outcomes of patients who have myocardial infarctions (MIs) in December are worse than the outcomes during other months. Some attribute this result to less use of evidence-based therapies during the holiday season. Contribution From January 1994 through February 1996, Medicare beneficiaries hospitalized with acute MI in December received evidence-based therapies at the same rate as patients hospitalized in other months but had slightly higher 30-day mortality rates (21.7% vs. 20.1%; P < 0.001). Implications Worse outcomes in patients with MI during December are not attributable to less frequent use of evidence-based therapies. –The Editors

 

Author and Article Information

From Duke University Medical Center, Durham, North Carolina; and Mayo Clinic, Rochester, Minnesota.

Note: This study was presented in poster form at the American College of Cardiology 53rd Annual Scientific Session, New Orleans, Louisiana, March 2004.

Disclaimer: The contents of this article do not necessarily reflect the views of the Department of Health and Human Services, nor does the mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Health Care Financing Administration, which has encouraged identification of quality improvement projects derived from analysis of patterns of care.

Acknowledgments: The authors thank Damon Seils for editorial assistance and manuscript preparation. Data were provided by the Delmarva Foundation for Medical Care, Inc., and the Centers for Medicare & Medicaid Services, both in Baltimore, Maryland.

Grant Support: None.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Trip J. Meine, MD, 877-B West Faris Road, Greenville, SC 29605.

Current Author Addresses: Drs. Meine, Patel, Curtis, Rao, Schulman, and Jollis and Ms. DePuy: Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715.

Dr. Gersh: Mayo Clinic, Cardiovascular Division, 200 First Street SW, Rochester, MN 55905.

Author Contributions: Conception and design: T.J. Meine, M.R. Patel, S.V. Rao, K.A. Schulman, J.G. Jollis.

Analysis and interpretation of the data: T.J. Meine, M.R. Patel, V. DePuy, L.H. Curtis, S.V. Rao, K.A. Schulman, J.G. Jollis.

Drafting of the article: T.J. Meine, M.R. Patel, B.J. Gersh.

Critical revision of the article for important intellectual content: T.J. Meine, M.R. Patel, V. DePuy, L.H. Curtis, S.V. Rao, B.J. Gersh, K.A. Schulman, J.G. Jollis.

Final approval of the article: T.J. Meine, M.R. Patel, L.H. Curtis, S.V. Rao, B.J. Gersh, K.A. Schulman, J.G. Jollis.

Provision of study materials or patients: L.H. Curtis, S.V. Rao, K.A. Schulman.

Statistical expertise: V. DePuy, L.H. Curtis, J.G. Jollis.

Obtaining of funding: J.G. Jollis.

Administrative, technical, or logistic support: M.R. Patel, L.H. Curtis, K.A. Schulman.

Collection and assembly of data: J.G. Jollis.

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