Do "America's best hospitals" perform better for acute myocardial infarction?

Background "America's Best Hospitals," an influential list published annual ly by U.S. News & World Report, assesses the quality of hospitals. It is no t known whether patients admitted to hospitals ranked at the top in cardiol ogy have lower short-term mortality from acute myocardial infarction than t hose admitted to other hospitals or whether differences in mortality are ex plained by differential use of recommended therapies. Methods Using data from the Cooperative Cardiovascular Project on 149,177 e lderly Medicare beneficiaries with acute myocardial infarction in 1994 or 1 995, we examined the care and outcomes of patients admitted to three types of hospitals: those ranked high in cardiology (top-ranked hospitals); hospi tals not in the top rank that had on-site facilities for cardiac catheteriz ation, coronary angioplasty, and bypass surgery (similarly equipped hospita ls); and the remaining hospitals (non-similarly equipped hospitals). We com pared 30-day mortality; the rates of use of aspirin, beta-blockers, and rep erfusion; and the relation of differences in rates of therapy to shortterm mortality. Results Admission to a top-ranked hospital was associated with lower adjust ed 30-day mortality (odds ratio, 0.87; 95 percent confidence interval, 0.76 to 1.00; P = 0.05 for top-ranked hospitals vs. the others). Among patients without contraindications to therapy, top-ranked hospitals had significant ly higher rates of use of aspirin (96.2 percent, as compared with 88.6 perc ent for similarly equipped hospitals and 83.4 percent for non-similarly equ ipped hospitals; P < 0.01) and beta-blockers (75.0 percent vs. 61.8 percent and 58.7 percent, P < 0.01), but lower rates of reperfusion therapy (61.0 percent vs. 70.7 percent and 65.6 percent, P = 0.03). The survival advantag e associated with admission to top-ranked hospitals was less strong after w e adjusted for factors including the use of aspirin and beta-blockers (odds ratio, 0.94; 95 percent confidence interval, 0.82 to 1.08; P = 0.38). Conclusions Admission to a hospital ranked high on the list of "America's B est Hospitals" was associated with lower 30-day mortality among elderly pat ients with acute myocardial infarction. A substantial portion of the surviv al advantage may be associated with these hospitals' higher rates of use of aspirin and beta-blocker therapy. (N Engl J Med 1999;340: 286-92.) (C) 199 9, Massachusetts Medical Society.