Variation Between Hospitals in Short-term Mortality After Acute Coronary Syndromes: A CALIBER Study
NCT ID: NCT01111071
Last Updated: 2016-05-12
Study Results
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Basic Information
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COMPLETED
316648 participants
OBSERVATIONAL
2010-04-30
2014-12-31
Brief Summary
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Detailed Description
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* use of in-hospital mortality as an outcome measure, which can be affected by length of stay,
* restriction to patients aged 65 and over, or otherwise selected patients, and
* patient-level explanatory factors lacking clinical detail, particularly medications given in hospital.
MINAP patient-level data allow the investigation of hospital variation in mortality (in-hospital and 30-day) in a group of unselected patients, taking into account clinical details such as medication use in hospital, as well as features of the hospitals providing care. The proposed study will establish the extent of variation between hospitals in England and Wales, whether this varies by ACS diagnosis, whether the variation has reduced over time and finally which patient-level or hospital-level factors explain any variation found.
A statistical analytic protocol for this study, dated 15.4.2010, is available on request.
This study is part of the CALIBER (Cardiovascular disease research using linked bespoke studies and electronic records) programme funded over 5 years from the NIHR and Wellcome Trust. The central theme of the CALIBER research is linkage of the Myocardial Ischaemia National Audit Project (MINAP) with primary care (GPRD) and other resources. The overarching aim of CALIBER is to better understand the aetiology and prognosis of specific coronary phenotypes across a range of causal domains, particularly where electronic records provide a contribution beyond traditional studies. CALIBER has received both Ethics approval (ref 09/H0810/16) and ECC approval (ref ECC 2-06(b)/2009 CALIBER dataset).
Conditions
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Study Design
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PROSPECTIVE
Study Groups
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STEMI
patients with discharge diagnosis of ST elevation myocardial infarction
No interventions assigned to this group
nSTEMI
patients with discharge diagnosis of non ST elevation myocardial infarction
No interventions assigned to this group
unstable angina
patients with discharge diagnosis of unstable angina
No interventions assigned to this group
Eligibility Criteria
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Inclusion Criteria
Exclusion Criteria
30 Years
ALL
No
Sponsors
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Barts & The London NHS Trust
OTHER
Queen Mary University of London
OTHER
University of Bristol
OTHER
Yale University
OTHER
University College, London
OTHER
Responsible Party
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Julie George
NIHR Doctoral Fellow
Principal Investigators
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Julie L George, MSc
Role: PRINCIPAL_INVESTIGATOR
University College, London
Locations
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Epidemiology and Public Health, University College London
London, , United Kingdom
Countries
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References
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Bradley EH, Herrin J, Elbel B, McNamara RL, Magid DJ, Nallamothu BK, Wang Y, Normand SL, Spertus JA, Krumholz HM. Hospital quality for acute myocardial infarction: correlation among process measures and relationship with short-term mortality. JAMA. 2006 Jul 5;296(1):72-8. doi: 10.1001/jama.296.1.72.
Heidenreich PA, Lewis WR, LaBresh KA, Schwamm LH, Fonarow GC. Hospital performance recognition with the Get With The Guidelines Program and mortality for acute myocardial infarction and heart failure. Am Heart J. 2009 Oct;158(4):546-53. doi: 10.1016/j.ahj.2009.07.031.
Peterson ED, Roe MT, Mulgund J, DeLong ER, Lytle BL, Brindis RG, Smith SC Jr, Pollack CV Jr, Newby LK, Harrington RA, Gibler WB, Ohman EM. Association between hospital process performance and outcomes among patients with acute coronary syndromes. JAMA. 2006 Apr 26;295(16):1912-20. doi: 10.1001/jama.295.16.1912.
Alter DA, Austin PC, Tu JV; Canadian Cardiovascular Outcomes Research Team. Community factors, hospital characteristics and inter-regional outcome variations following acute myocardial infarction in Canada. Can J Cardiol. 2005 Mar;21(3):247-55.
Krumholz HM, Chen J, Wang Y, Radford MJ, Chen YT, Marciniak TA. Comparing AMI mortality among hospitals in patients 65 years of age and older: evaluating methods of risk adjustment. Circulation. 1999 Jun 15;99(23):2986-92. doi: 10.1161/01.cir.99.23.2986.
Krumholz HM, Wang Y, Mattera JA, Wang Y, Han LF, Ingber MJ, Roman S, Normand SL. An administrative claims model suitable for profiling hospital performance based on 30-day mortality rates among patients with an acute myocardial infarction. Circulation. 2006 Apr 4;113(13):1683-92. doi: 10.1161/CIRCULATIONAHA.105.611186. Epub 2006 Mar 20.
Krumholz HM, Wang Y, Chen J, Drye EE, Spertus JA, Ross JS, Curtis JP, Nallamothu BK, Lichtman JH, Havranek EP, Masoudi FA, Radford MJ, Han LF, Rapp MT, Straube BM, Normand SL. Reduction in acute myocardial infarction mortality in the United States: risk-standardized mortality rates from 1995-2006. JAMA. 2009 Aug 19;302(7):767-73. doi: 10.1001/jama.2009.1178.
Granger CB, Steg PG, Peterson E, Lopez-Sendon J, Van de Werf F, Kline-Rogers E, Allegrone J, Dabbous OH, Klein W, Fox KA, Eagle KA; GRACE Investigators. Medication performance measures and mortality following acute coronary syndromes. Am J Med. 2005 Aug;118(8):858-65. doi: 10.1016/j.amjmed.2005.01.070.
Rasmussen S, Zwisler AD, Abildstrom SZ, Madsen JK, Madsen M. Hospital variation in mortality after first acute myocardial infarction in Denmark from 1995 to 2002: lower short-term and 1-year mortality in high-volume and specialized hospitals. Med Care. 2005 Oct;43(10):970-8. doi: 10.1097/01.mlr.0000178195.07110.d3.
Rasmussen S, Abildstrom SZ, Rasmussen JN, Gislason GH, Schramm TK, Folke F, Kober L, Torp-Pedersen C, Madsen M. Hospital variation in use of secondary preventive medicine after discharge for first acute myocardial infarction during 1995-2004. Med Care. 2008 Jan;46(1):70-7. doi: 10.1097/MLR.0b013e3181484952.
Rosato S, Seccareccia F, D'Errigo P, Fusco D, Maraschini A, Badoni G, Perucci CA. Thirty-day mortality after AMI: effect modification by gender in outcome studies. Eur J Public Health. 2010 Aug;20(4):397-402. doi: 10.1093/eurpub/ckp194. Epub 2009 Nov 27.
Popescu I, Werner RM, Vaughan-Sarrazin MS, Cram P. Characteristics and outcomes of America's lowest-performing hospitals: an analysis of acute myocardial infarction hospital care in the United States. Circ Cardiovasc Qual Outcomes. 2009 May;2(3):221-7. doi: 10.1161/CIRCOUTCOMES.108.813790. Epub 2009 May 5.
Kosseim M, Mayo NE, Scott S, Hanley JA, Brophy J, Gagnon B, Pilote L. Ranking hospitals according to acute myocardial infarction mortality: should transfers be included? Med Care. 2006 Jul;44(7):664-70. doi: 10.1097/01.mlr.0000215848.87202.c7.
Murphy NF, MacIntyre K, Stewart S, Capewell S, McMurray JJ. Reduced between-hospital variation in short term survival after acute myocardial infarction: the result of improved cardiac care? Heart. 2005 Jun;91(6):726-30. doi: 10.1136/hrt.2004.042929.
Leyland AH, Boddy FA. League tables and acute myocardial infarction. Lancet. 1998 Feb 21;351(9102):555-8. doi: 10.1016/S0140-6736(97)09362-8.
Related Links
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CArdiovascular disease research Linking Bespoke studies and Electronic Records
Other Identifiers
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RP-PG-0407-10314
Identifier Type: OTHER_GRANT
Identifier Source: secondary_id
CALIBER-09-03
Identifier Type: -
Identifier Source: org_study_id
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