Relationship between annual volume of patients treated by admitting physician and mortality after acute myocardial infarction

Context Acute myocardial infarction (AMI) is a common condition that is tre ated by physicians with varying levels of clinical experience, but whether the level of experience affects outcome remains uncertain. Objective To evaluate the relationship between the average annual volume of cases treated by admitting physicians and mortality after AMI. Design, Setting, and Patients Retrospective cohort study using linked admin istrative databases containing patient admission information for 98 194 pat ients treated by 5374 physicians between April 1, 1992, and March 31, 1998, in Ontario, Canada. Main Outcome Measures Mortality risk rates for 30 days and 1 year post-AMI, adjusted by physician volume and patient, physician, and hospital characte ristics. Results The 30-day mortality rate was 13.5% and the 1-year mortality rate w as 21.8%, A strong inverse relationship between the average annual volume o f AMI cases treated by the admitting physician and mortality after an AMI w as observed. The 30-day risk-adjusted mortality rate was 15.3% for physicia ns who treated 5 or fewer AMI cases per year (lowest quartile) compared wit h 11.8% for physicians who treated more than 24 AMI cases annually (highest quartile; P<.001). The 1-year risk-adjusted mortality rate was 24.2% for p hysicians who treated 5 or fewer AMI cases per year (lowest quartile) compa red with 19.6% for physicians who treated more than 24 AMI cases annually ( highest quartile; P<.001). Conclusion Patients with AMI who are treated by high-volume admitting physi cians are more likely to survive at 30 days and 1 year.