Document Detail

A simple benchmark for evaluating quality of care of patients following acute myocardial infarction.
MedLine Citation:
PMID:  11454829     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To develop a simple risk model as a basis for evaluating care of patients admitted with acute myocardial infarction. METHODS: From coronary care registers, biochemistry records and hospital management systems, 2153 consecutive patients with confirmed acute myocardial infarction were identified. With 30 day all cause mortality as the end point, a multivariable logistic regression model of risk was constructed and validated in independent patient cohorts. The areas under receiver operating characteristic curves were calculated as an assessment of sensitivity and specificity. The model was reapplied to a number of commonly studied subgroups for further assessment of robustness. RESULTS: A three variable model was developed based on age, heart rate, and systolic blood pressure on admission. This produced an individual probability of death by 30 days (P(30)) where P(30) = 1/(1 + exp(-L(30))) and L(30) = -5.624 + (0.085 x age) + (0.014 x heart rate) - (0.022 x systolic blood pressure). The areas under the receiver operating characteristic curves for the reference and test cohorts were 0.79 (95% CI 0.76 to 0.82) and 0.76 (95% CI 0.72 to 0.79), respectively. To aid application of the model to routine clinical audit, a normogram relating observed mortality and sample size to the likelihood of a significant deviation from the expected 30 day mortality rate was constructed. CONCLUSIONS: This risk model is simple, reproducible, and permits quality of care of acute myocardial infarction patients to be reliably evaluated both within and between centres.
M F Dorsch; R A Lawrance; R J Sapsford; J Oldham; D C Greenwood; B M Jackson; C Morrell; S G Ball; M B Robinson; A S Hall
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  86     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2001 Aug 
Date Detail:
Created Date:  2001-07-16     Completed Date:  2001-08-09     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  150-4     Citation Subset:  AIM; IM    
The BHF Heart Research Centre, G-Floor, Jubilee Building, Leeds General Infirmary, Leeds LS1 3EX, UK.
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MeSH Terms
Benchmarking / methods*
Cohort Studies
England / epidemiology
Hospital Mortality
Logistic Models
Middle Aged
Myocardial Infarction / diagnosis,  mortality*,  therapy*
Outcome Assessment (Health Care) / methods*
Risk Assessment / methods

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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