Do patients treated at academic hospitals have better longitudinal outcomes after admission for non-ST-elevation myocardial infarction?

Emily O'Brien, Sumeet Subherwal, Matthew T. Roe, Dajuanicia N. Holmes, Laine Thomas, Karen P. Alexander, Tracy Y. Wang, Eric D. Peterson

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background Prior studies have found that academic hospitals provide more consistent use of guideline-recommended therapies in patients with non-ST-segment myocardial infarction (NSTEMI) compared with nonacademic centers, yet it is unclear whether these care differences translate into longer-term outcome differences. Methods Using data from the CRUSADE Registry linked to Center for Medicare & Medicaid Services claims, we compared 30-day and 1-year all-cause mortality among 12,194 older patients with NSTEMI (age ≥65 years) treated at 103 academic centers and 28,335 patients treated at 302 nonacademic centers from February 2003 to December 2006. Outcomes were first adjusted for clinical characteristics, followed by adjustment for hospital performance, on 13 acute and discharge guideline-recommended therapies using a shared frailty model (an extension of the Cox proportional hazard model). Results Compared with older patients with NSTEMI treated at nonacademic hospitals, those treated at academic hospitals had greater and more consistent use of evidence-based acute and discharge therapies, were more likely to receive in-hospital revascularization (61.1% vs 54.2%; P &lt0001), and had modestly lower risk-adjusted 30-day mortality after adjustment for patient-level clinical characteristics (8.9% vs 10.2%, adjusted hazard ratio [HR] 0.89, 95% CI 0.80-0.99). These differences were attenuated (HR 0.94, 95% CI 0.83-1.02) after further adjustment for hospital delivery of evidence-based treatments, yet did not persist out to 1 year (unadjusted HR 0.92, 95% CI 0.84-1.01, P =.089). Conclusions Patients with NSTEMI treated at academic centers are more likely to receive guideline-recommended therapies and had modestly better 30-day outcomes. Nevertheless, these differences do not persist out to 1 year.

Original languageEnglish (US)
Pages (from-to)762-769
Number of pages8
JournalAmerican heart journal
Issue number5
StatePublished - May 2014
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Do patients treated at academic hospitals have better longitudinal outcomes after admission for non-ST-elevation myocardial infarction?'. Together they form a unique fingerprint.

Cite this