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Abstract
Background The Summary Hospital-level Mortality Indicator (SHMI) for Myocardial Infarction (MI) is the ratio of the observed to the expected number of deaths due to MI. We aimed to assess (1) the accuracy of MI as a diagnosis in the SHMI for MI and (2) the healthcare received by patients with type 1 MI included in the SHMI for MI.
Methods Retrospective review of patients included in SHMI for MI from April 2017 to March 2018. The diagnosis of MI was divided into type 1, type 2 and non-MI. For patients with type 1 MI who underwent intervention, we applied the prognostic Toronto Risk Score (TRS) and classified into group 0: score <13 (mortality risk 0%–4%, lowest risk), group 1: score 13–16 (mortality risk 6%–19.6%), group 2: score 17–19 (mortality risk 27.4%–47.6%) and group 3: score ≥20 (mortality risk 58%–92%). For patients with type 1 MI who underwent conservative management, we reviewed appropriateness of conservative management.
Results SHMI for MI was 96 (41/42.83) falling to 65.4 with the inclusion of only type 1 MI (28 patients, 28/42.83). About 41.5% (n=17) underwent intervention of whom three were in the lowest risk TRS (group 0) and all received appropriate healthcare. Conservative management was appropriate for the 26.8% (n=11) treated medically, the most common reason was severe cognitive dysfunction.
Conclusions We have demonstrated that SHMI for MI can be inaccurate due to the inclusion of type 2 MI or non-MI. Grouping patients into intervention versus conservative management helps in assessment of healthcare.
- quality measurement
- mortality (standardized mortality ratios)
- coronary disease
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Footnotes
Twitter @vinoda_sharma
Contributors VS planned the study, helped in data collection and analysis, manuscript write-up and was responsible for overall content. SQ performed the manuscript write-up/revision. FA helped in data collection and analysis and was responsible for content. VZ helped in manuscript write-up/revision. CV planned the study and helped in manuscript write-up/revision.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.