Regional variation in the treatment and outcomes of myocardial infarction: investigating New England's advantage.
BACKGROUND
Previous studies have reported that myocardial infarction (MI) treatment in New England differs from that of other regions of the United States. We sought to determine whether regional differences in MI treatment were independent of regional differences in patient, hospital, or physician characteristics, and whether the New England region's practice pattern was associated with better outcomes than those of patients in other regions.


METHODS
We evaluated 167,180 patients aged > or =65 years who were hospitalized with MI between 1994 to 1996 to assess regional variations in quality of care. Patients were evaluated for the use of reperfusion therapy, aspirin, and beta-blockers on admission and 30-day mortality rate. Hierarchical logistic regression models were used to determine whether practice patterns specific to New England were independent of regional variations in patient, physician, hospital, or other geographic characteristics.


RESULTS
New England had the highest use of beta-blockers (72% vs 52% other regions, P <.001), and aspirin (80% vs 76% other regions, P <.001), a lower use of reperfusion therapy (61% vs 67% other regions, P <.001), and the lowest risk-standardized 30-day mortality rate (15% vs 19% other regions, P <.001). These differences persisted after adjusting for patient, physician, and hospital characteristics.


CONCLUSIONS
Patients with MI in New England have higher rates of medical therapy use and lower 30-day mortality rates than patients in other US regions. This pattern is independent of patient or provider characteristics, suggesting other factors likely contribute to better short-term outcomes in New England.
Krumholz
Harlan M
HM
Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Conn 06520-8088, USA.
Chen
Jersey
J
Rathore
Saif S
SS
Wang
Yun
Y
Radford
Martha J
MJ
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D001241:Aspirin / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy*; D009511:New England / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011787:Quality of Health Care; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists; D005343:Fibrinolytic Agents; D001241:Aspirin