Best Hospitals Not Always The Best for Heart Attack Patients
Heart attack patients admitted to hospitals ranked to be among "America's Best" by U.S. News & World Report are less likely to die within 30 days than those patients admitted to non-ranked hospitals, Yale School of Medicine researchers report in the July 9 Archives of Internal Medicine.
"The rankings, which include many of the nation's most prestigious hospitals, did identify a group of hospitals that was much more likely than non-ranked hospitals to have superb performance on 30-day mortality after acute myocardial infarction," said corresponding author Harlan M. Krumholz, M.D., The Harold H. Hines, Jr. Professor of Medicine and Epidemiology and Public Health at Yale School of Medicine. "But our study also shows that not all ranked hospitals had outstanding performance and that many non-ranked hospitals performed well."
Krumholz and his team compared 30-day death rates for 13,662 acute myocardial infarction (AMI) patients in 50 U.S. News & World Report ranked hospitals with 254,907 AMI patients in 3,813 non-ranked hospitals. The study methods used were similar to recently released mortality measures that are publicly reported by the Centers for Medicare and Medicaid Services (CMS). The researchers compared the hospitals' standardized mortality ratios, where a ratio of greater than one indicates more deaths than expected and a ratio of less than one indicates fewer deaths than expected.
After factoring in patient characteristics the 30-day death rates were, on average, lower in ranked hospitals vs. non-ranked hospitals by about 2 percent. When the hospitals were divided into four groups based on these rates, about 70 percent of ranked hospitals were in the group with the fewest deaths, 22 percent were in the middle two groups and eight percent were in the worst performing groups.
U.S. News & World Report's annual issue of "America's Best Hospitals" for specialty and overall care is one of the most well known academic, industry and governmental profiling systems that evaluate and compare hospitals. "Despite their prominent role in the public arena, the ability of these rankings to identify hospitals with excellent survival rates for patients with heart attacks is not known," said Krumholz.
The study also found that 22 percent of ranked hospitals and about one percent of non-ranked hospitals had standardized mortality ratios significantly less than one, meaning that although ranked hospitals were more likely to have lower than expected death rates, non-ranked hospitals with favorable ratios outnumbered ranked hospitals with similar performance by nearly three to one. As a result, the U.S. News & World Report ranking list does not include many hospitals that have outstanding performances for the care of heart attack patients. The authors speculate that the reputation component of the rankings may be to blame. Reputation accounts for one-third of the overall ranking score and is based on cardiologists' opinions of hospitals that provide the best treatment, which may not always correspond to actual performance.
Other authors on the study included first author Oliver J. Wang, M.D., Yun Wang, Judith H. Lichtman, Elizabeth H. Bradley (all from Yale School of Medicine) and Sharon-Lise T. Normand from Harvard Medical School.
Citation: Archives of Internal Medicine 167 (13): 1345-1351 (July 9, 2007)