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October 3, 2001

Relationship of Physician Volume to Mortality After Acute Myocardial Infarction

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(13):1574-1575. doi:10.1001/jama.286.13.1573

To the Editor: Dr Tu and colleagues1 reported that mortality following acute myocardial infarction (AMI) was related to the volume of similar patients treated by the physician. Their recommendation that "shifting the care of more AMI patients to a smaller number of high volume physicians could potentially result in a significant decrease in the number of AMI deaths that occur each year," is not justified. Patients with physicians who saw over 24 cases a year had lower 30-day and 1-year mortality but this may reflect favorable selection bias. Physicians who cared for only 1 to 5 cases of AMI per year had higher mortality but their patients also had higher comorbidity (increased age, acute and chronic renal failure, diabetes, stroke, cancer, and congestive heart failure). Unfortunately, selection bias is not adequately handled by multivariate regression analyses.