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A detailed analysis of patients included in the Summary Hospital-level Mortality Indicator (SHMI) for myocardial infarction (MI)—all is not what it seems?

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...

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Autores principales: Sharma, Vinoda, Chowdhary, Saqib, Abdul, Fairoz, Džavík, Vladimír, Varma, Chetan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292047/
https://www.ncbi.nlm.nih.gov/pubmed/32522727
http://dx.doi.org/10.1136/bmjoq-2019-000836
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author Sharma, Vinoda
Chowdhary, Saqib
Abdul, Fairoz
Džavík, Vladimír
Varma, Chetan
author_facet Sharma, Vinoda
Chowdhary, Saqib
Abdul, Fairoz
Džavík, Vladimír
Varma, Chetan
author_sort Sharma, Vinoda
collection PubMed
description 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.
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spelling pubmed-72920472020-06-16 A detailed analysis of patients included in the Summary Hospital-level Mortality Indicator (SHMI) for myocardial infarction (MI)—all is not what it seems? Sharma, Vinoda Chowdhary, Saqib Abdul, Fairoz Džavík, Vladimír Varma, Chetan BMJ Open Qual Original Research 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. BMJ Publishing Group 2020-06-09 /pmc/articles/PMC7292047/ /pubmed/32522727 http://dx.doi.org/10.1136/bmjoq-2019-000836 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Original Research
Sharma, Vinoda
Chowdhary, Saqib
Abdul, Fairoz
Džavík, Vladimír
Varma, Chetan
A detailed analysis of patients included in the Summary Hospital-level Mortality Indicator (SHMI) for myocardial infarction (MI)—all is not what it seems?
title A detailed analysis of patients included in the Summary Hospital-level Mortality Indicator (SHMI) for myocardial infarction (MI)—all is not what it seems?
title_full A detailed analysis of patients included in the Summary Hospital-level Mortality Indicator (SHMI) for myocardial infarction (MI)—all is not what it seems?
title_fullStr A detailed analysis of patients included in the Summary Hospital-level Mortality Indicator (SHMI) for myocardial infarction (MI)—all is not what it seems?
title_full_unstemmed A detailed analysis of patients included in the Summary Hospital-level Mortality Indicator (SHMI) for myocardial infarction (MI)—all is not what it seems?
title_short A detailed analysis of patients included in the Summary Hospital-level Mortality Indicator (SHMI) for myocardial infarction (MI)—all is not what it seems?
title_sort detailed analysis of patients included in the summary hospital-level mortality indicator (shmi) for myocardial infarction (mi)—all is not what it seems?
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292047/
https://www.ncbi.nlm.nih.gov/pubmed/32522727
http://dx.doi.org/10.1136/bmjoq-2019-000836
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