Variation Between Hospitals in Short-term Mortality After Acute Coronary Syndromes: A CALIBER Study

NCT01111071 | Completed DMC

• 2 other identifiers: CALIBER-09-03RP-PG-0407-10314
• Study Type: observational
• Target: 316,648
• Locations: 1 country
• Sites: 1

Brief Summary

We seek to investigate whether hospitals in England and Wales vary in their rate of mortality following admission for heart attack or unstable angina, the extent of such variation, whether discharge diagnosis affects the extent of variation, and whether such variation has changed over time. Furthermore, we will investigate what individual- or hospital-level factors explain variation in mortality between hospitals.

Conditions

Acute Coronary Syndrome

Keywords

hospital variation; 30 day mortality; in hospital mortality; acute coronary syndrome; myocardial infarction; unstable angina; hospital performance; trends

Outcome Measures

Primary Outcomes (1)

• all-cause 30-day mortality

  all-cause 30-day mortality following hospitalisation for acute coronary syndrome

  30 day

Secondary Outcomes (1)

• all-cause in-hospital mortality

  length of hospital stay

Study Arms (3)

STEMI

patients with discharge diagnosis of ST elevation myocardial infarction

nSTEMI

patients with discharge diagnosis of non ST elevation myocardial infarction

unstable angina

patients with discharge diagnosis of unstable angina

Eligibility Criteria

• Age: 30 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients admitted with acute coronary syndrome to acute hospitals in England and Wales participating in the Myocardial Ischaemia National Audit Project (MINAP)

You may qualify if:

• admitted between January 2003 to June 2009 (or latest date data available)

You may not qualify if:

• admitted to hospital with fewer than 25 admissions in given year

Sponsors & Collaborators

• University College, London: lead
• Barts & The London NHS Trust: collaborator
• Queen Mary University of London: collaborator
• University of Bristol: collaborator
• Yale University: collaborator

Study Sites (1)

Epidemiology and Public Health, University College London

London, WC1E 6BT, United Kingdom

Location

Related Publications (15)

• 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.

  PMID: 16820549 BACKGROUND

• 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.

  PMID: 19781413 BACKGROUND

• 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.

  PMID: 16639050 BACKGROUND

• 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.

  PMID: 15776114 BACKGROUND

• 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.

  PMID: 10368115 BACKGROUND

• 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.

  PMID: 16549637 BACKGROUND

• 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.

  PMID: 19690309 BACKGROUND

• 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.

  PMID: 16084178 BACKGROUND

• 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.

  PMID: 16166866 BACKGROUND

• 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.

  PMID: 18162858 BACKGROUND

• 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.

  PMID: 19946045 BACKGROUND

• 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.

  PMID: 20031841 BACKGROUND

• 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.

  PMID: 16799361 BACKGROUND

• 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.

  PMID: 15894761 BACKGROUND

• 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.

  PMID: 9492774 BACKGROUND

Related Links

• CArdiovascular disease research Linking Bespoke studies and Electronic Records

MeSH Terms

Conditions

Acute Coronary Syndrome; Myocardial Infarction; Angina, Unstable

Condition Hierarchy (Ancestors)

Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Vascular Diseases; Infarction; Ischemia; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Necrosis; Angina Pectoris; Chest Pain; Pain; Neurologic Manifestations; Signs and Symptoms

Study Officials

• Julie L George, MSc

  University College, London

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: NIHR Doctoral Fellow

Study Record Dates

• First Submitted: April 16, 2010
• First Posted: April 27, 2010
• Study Start: April 1, 2010
• Primary Completion: September 1, 2014
• Study Completion: December 1, 2014
• Last Updated: May 12, 2016

Record last verified: 2016-05

Data Sharing

• IPD Sharing: Will not share

Locations

GB (1)