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Brief Report
April 2018

US National Trends in Mortality From Acute Myocardial Infarction and Heart FailurePolicy Success or Failure?

Author Affiliations
  • 1Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 2The Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia
  • 3The Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri
  • 4The Washington University Brown School of Social Work, St Louis, Missouri
JAMA Cardiol. 2018;3(4):336-340. doi:10.1001/jamacardio.2018.0218
Key Points

Question  How have mortality rates at baseline poor-performing hospitals for acute myocardial infarction and heart failure changed in response to policies of the past decade, including public reporting and value-based payment programs?

Findings  In this cross-sectional study, for acute myocardial infarction, 30-day mortality among baseline poor performers was higher at baseline but improved more over time compared with other hospitals (18.6% in 2009 to 14.6% in 2015 vs 15.7% to 14.0%). In contrast, for heart failure, baseline poor performers improved over time (13.5% to 13.0%), but mortality among all other heart failure hospitals increased (10.9% to 12.0%).

Meaning  Despite being subject to identical policy pressures, mortality trends for acute myocardial infarction and heart failure differed markedly between 2009 and 2015.

Abstract

Importance  Hospitals in the United States have been subject to mandatory public reporting of mortality rates for acute myocardial infarction (AMI) and heart failure (HF) since 2007 and to value-based payment programs for these conditions since 2011. However, whether hospitals with initially poor baseline performance have improved relative to other hospitals under these programs, and whether patterns of improvement differ by condition, is unknown. Understanding trends within public reporting and value-based payment can inform future efforts in these areas.

Objective  To examine patterns in 30-day mortality from AMI and HF and determine whether they differ for baseline poor performers (worst quartile in 2009 and 2010 in public reporting, prior to value-based payment) compared with other hospitals.

Design, Setting, and Participants  Retrospective cross-sectional study at US acute care hospitals from 2009 to 2015 that included 2751 and 3796 hospitals with publicly reported mortality data for AMI and HF, respectively.

Exposures  Public reporting and value-based purchasing.

Main Outcomes and Measures  Hospital-level risk-adjusted 30-day mortality rates.

Results  We identified 422 and 600 baseline poor-performing hospitals for AMI and HF, respectively. Baseline poor performers for AMI were more often public and for-profit and less often teaching hospitals. Baseline poor performers for HF were less often large hospitals. For AMI, 30-day mortality among baseline poor performers was higher at baseline but improved more over time compared with other hospitals (18.6% in 2009 to 14.6% in 2015; −0.74% per year; P < .001 vs 15.7% in 2009 to 14.0% in 2015; −0.26% per year; P < .001; P for interaction <.001). In contrast, for HF, baseline poor performers improved over time (13.5%-13.0%; −0.12% per year; P < .001), but mean mortality among all other HF hospitals increased during the study period (10.9%-12.0%; 0.17% per year; P < .001; P for interaction, <.001).

Conclusions and Relevance  Despite being subject to identical policy pressures, mortality trends for AMI and HF differed markedly between 2009 and 2015.

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