Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
Copyright 2001 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.2001
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
Campbell WB. Relationship of Physician Volume to Mortality After Acute Myocardial Infarction. JAMA. 2001;286(13):1574-1575. doi:10.1001/jama.286.13.1573