A European benchmarking system to evaluate in-hospital mortality rates in acute coronary syndrome: The EURHOBOP project.

BACKGROUND: Hospital performance models in acute myocardial infarction (AMI) are useful to assess patient management. While models are available for individual countries, mainly US, cross-European performance models are lacking. Thus, we aimed to develop a system to benchmark European hospitals in A...

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Autores: Dégano, Irene R., Subirana Cachinero, Isaac, Torre, Marina, Grau Magaña, Maria, Vila, Joan, Fusco, Danilo, Kirchberger, Inge, Ferrières, Jean, Malmivaara, Antti, Azevedo, Ana, Meisinger, Christa, Bongard, Vanina, Farmakis, Dimitrios, Davoli, Marina, Häkkinen, Unto, Araújo, Carla, Lekakis, John, Elosua Llanos, Roberto, Marrugat, Jaume, 1954-
Tipo de recurso: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2015
País:España
Institución:Universitat Pompeu Fabra
Repositorio:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/23458
Acceso en línea:http://hdl.handle.net/10230/23458
http://dx.doi.org/10.1016/j.ijcard.2015.01.019
Access Level:acceso abierto
Palabra clave:Infart de miocardi
Mortalitat
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spelling A European benchmarking system to evaluate in-hospital mortality rates in acute coronary syndrome: The EURHOBOP project.Dégano, Irene R.Subirana Cachinero, IsaacTorre, MarinaGrau Magaña, MariaVila, JoanFusco, DaniloKirchberger, IngeFerrières, JeanMalmivaara, AnttiAzevedo, AnaMeisinger, ChristaBongard, VaninaFarmakis, DimitriosDavoli, MarinaHäkkinen, UntoAraújo, CarlaLekakis, JohnElosua Llanos, RobertoMarrugat, Jaume, 1954-Infart de miocardiMortalitatBACKGROUND: Hospital performance models in acute myocardial infarction (AMI) are useful to assess patient management. While models are available for individual countries, mainly US, cross-European performance models are lacking. Thus, we aimed to develop a system to benchmark European hospitals in AMI and percutaneous coronary intervention (PCI), based on predicted in-hospital mortality. METHODS AND RESULTS: We used the EURopean HOspital Benchmarking by Outcomes in ACS Processes (EURHOBOP) cohort to develop the models, which included 11,631 AMI patients and 8276 acute coronary syndrome (ACS) patients who underwent PCI. Models were validated with a cohort of 55,955 European ACS patients. Multilevel logistic regression was used to predict in-hospital mortality in European hospitals for AMI and PCI. Administrative and clinical models were constructed with patient- and hospital-level covariates, as well as hospital- and country-based random effects. Internal cross-validation and external validation showed good discrimination at the patient level and good calibration at the hospital level, based on the C-index (0.736-0.819) and the concordance correlation coefficient (55.4%-80.3%). Mortality ratios (MRs) showed excellent concordance between administrative and clinical models (97.5% for AMI and 91.6% for PCI). Exclusion of transfers and hospital stays ≤1day did not affect in-hospital mortality prediction in sensitivity analyses, as shown by MR concordance (80.9%-85.4%). Models were used to develop a benchmarking system to compare in-hospital mortality rates of European hospitals with similar characteristics. CONCLUSIONS: The developed system, based on the EURHOBOP models, is a simple and reliable tool to compare in-hospital mortality rates between European hospitals in AMI and PCI.This work was supported by the SANCO EAHC grants (EUPHORIC 2003/134 and EURHOBOP 2008/1312), the Health Institute Carlos IIIFEDER (HERACLES Spanish Cardiovascular Research Network RD06/ 0009 and RD12/0042, CB06/02/0029 and CP12/03287 to MG) and the Catalan Agency for Management of University and Research Grants (2005SGR00577, 2009SGR1195 and 2014SGR240, and 2011BP-B00169 postdoctoral contract to IRD — Beatriu de Pinós Program co-financed by the European CommissionElsevier201520152015info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/23458http://dx.doi.org/10.1016/j.ijcard.2015.01.019reponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésInternational Journal of Cardiology 2015 Mar 1;182:509-16© Elsevier http://dx.doi.org/10.1016/j.ijcard.2015.01.019info:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/234582026-06-12T07:21:37Z
dc.title.none.fl_str_mv A European benchmarking system to evaluate in-hospital mortality rates in acute coronary syndrome: The EURHOBOP project.
title A European benchmarking system to evaluate in-hospital mortality rates in acute coronary syndrome: The EURHOBOP project.
spellingShingle A European benchmarking system to evaluate in-hospital mortality rates in acute coronary syndrome: The EURHOBOP project.
Dégano, Irene R.
Infart de miocardi
Mortalitat
title_short A European benchmarking system to evaluate in-hospital mortality rates in acute coronary syndrome: The EURHOBOP project.
title_full A European benchmarking system to evaluate in-hospital mortality rates in acute coronary syndrome: The EURHOBOP project.
title_fullStr A European benchmarking system to evaluate in-hospital mortality rates in acute coronary syndrome: The EURHOBOP project.
title_full_unstemmed A European benchmarking system to evaluate in-hospital mortality rates in acute coronary syndrome: The EURHOBOP project.
title_sort A European benchmarking system to evaluate in-hospital mortality rates in acute coronary syndrome: The EURHOBOP project.
dc.creator.none.fl_str_mv Dégano, Irene R.
Subirana Cachinero, Isaac
Torre, Marina
Grau Magaña, Maria
Vila, Joan
Fusco, Danilo
Kirchberger, Inge
Ferrières, Jean
Malmivaara, Antti
Azevedo, Ana
Meisinger, Christa
Bongard, Vanina
Farmakis, Dimitrios
Davoli, Marina
Häkkinen, Unto
Araújo, Carla
Lekakis, John
Elosua Llanos, Roberto
Marrugat, Jaume, 1954-
author Dégano, Irene R.
author_facet Dégano, Irene R.
Subirana Cachinero, Isaac
Torre, Marina
Grau Magaña, Maria
Vila, Joan
Fusco, Danilo
Kirchberger, Inge
Ferrières, Jean
Malmivaara, Antti
Azevedo, Ana
Meisinger, Christa
Bongard, Vanina
Farmakis, Dimitrios
Davoli, Marina
Häkkinen, Unto
Araújo, Carla
Lekakis, John
Elosua Llanos, Roberto
Marrugat, Jaume, 1954-
author_role author
author2 Subirana Cachinero, Isaac
Torre, Marina
Grau Magaña, Maria
Vila, Joan
Fusco, Danilo
Kirchberger, Inge
Ferrières, Jean
Malmivaara, Antti
Azevedo, Ana
Meisinger, Christa
Bongard, Vanina
Farmakis, Dimitrios
Davoli, Marina
Häkkinen, Unto
Araújo, Carla
Lekakis, John
Elosua Llanos, Roberto
Marrugat, Jaume, 1954-
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Infart de miocardi
Mortalitat
topic Infart de miocardi
Mortalitat
description BACKGROUND: Hospital performance models in acute myocardial infarction (AMI) are useful to assess patient management. While models are available for individual countries, mainly US, cross-European performance models are lacking. Thus, we aimed to develop a system to benchmark European hospitals in AMI and percutaneous coronary intervention (PCI), based on predicted in-hospital mortality. METHODS AND RESULTS: We used the EURopean HOspital Benchmarking by Outcomes in ACS Processes (EURHOBOP) cohort to develop the models, which included 11,631 AMI patients and 8276 acute coronary syndrome (ACS) patients who underwent PCI. Models were validated with a cohort of 55,955 European ACS patients. Multilevel logistic regression was used to predict in-hospital mortality in European hospitals for AMI and PCI. Administrative and clinical models were constructed with patient- and hospital-level covariates, as well as hospital- and country-based random effects. Internal cross-validation and external validation showed good discrimination at the patient level and good calibration at the hospital level, based on the C-index (0.736-0.819) and the concordance correlation coefficient (55.4%-80.3%). Mortality ratios (MRs) showed excellent concordance between administrative and clinical models (97.5% for AMI and 91.6% for PCI). Exclusion of transfers and hospital stays ≤1day did not affect in-hospital mortality prediction in sensitivity analyses, as shown by MR concordance (80.9%-85.4%). Models were used to develop a benchmarking system to compare in-hospital mortality rates of European hospitals with similar characteristics. CONCLUSIONS: The developed system, based on the EURHOBOP models, is a simple and reliable tool to compare in-hospital mortality rates between European hospitals in AMI and PCI.
publishDate 2015
dc.date.none.fl_str_mv 2015
2015
2015
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/acceptedVersion
format article
status_str acceptedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/23458
http://dx.doi.org/10.1016/j.ijcard.2015.01.019
url http://hdl.handle.net/10230/23458
http://dx.doi.org/10.1016/j.ijcard.2015.01.019
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv International Journal of Cardiology 2015 Mar 1;182:509-16
dc.rights.none.fl_str_mv © Elsevier http://dx.doi.org/10.1016/j.ijcard.2015.01.019
info:eu-repo/semantics/openAccess
rights_invalid_str_mv © Elsevier http://dx.doi.org/10.1016/j.ijcard.2015.01.019
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:Repositorio Digital de la UPF
instname:Universitat Pompeu Fabra
instname_str Universitat Pompeu Fabra
reponame_str Repositorio Digital de la UPF
collection Repositorio Digital de la UPF
repository.name.fl_str_mv
repository.mail.fl_str_mv
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