Abstract 248: Mortality and Readmission After Acute Myocardial Infarction in the Department of Veterans Affairs Health Care System

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Background: Little contemporary data about the performance of Veterans Affairs (VA) hospitals related to mortality and readmission rates after an acute myocardial infarction (MI) are available. Accordingly, we sought to characterize the rates of in-hospital and 30-day mortality and 30-day unplanned readmission after an acute MI as well as associated site-level variation.

Methods: Using data from the External Peer Review Program, which abstracts data from the records of all patients admitted with an acute MI, linked with administrative data from the Corporate Data Warehouse, we performed an observational analysis of patients admitted with an acute MI from January 1, 2011, to February 28, 2014.

Results: A total of 16,024 patients were admitted with an acute MI; 806 (5.0%) patients died during hospitalization, 1299 (8.1%) died within 30 days of admission, and 2529 (16.9%) had an unplanned hospital readmission. The annual risk-standardized in-hospital mortality rate (Hazard Ratio (HR) 0.90, 95% Credible Interval (CI) 0.83-0.98) and the 30-day mortality rate (HR 0.94, 95% CI 0.88-1.00) but not the unplanned readmission rate (HR 1.00, 95% CI 0.96-1.04) decreased over time (Figure). Individual hospital rates for in-hospital mortality, 30-day mortality, and 30-day unplanned readmission were comparable to the system-wide rates, with little variation between hospitals.

Conclusions: In Veterans Affairs hospitals from 2011 to 2014, in-hospital and 30-day mortality but not 30-day unplanned readmissions rates declined over time. Little site-level variation in mortality or readmission rates was observed.

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