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Usual Source of Care and Outcomes Following Acute Myocardial Infarction

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Abstract

Background

The quality of the relationship between a patient and their usual source of care may impact outcomes, especially after an acute clinical event requiring regular follow-up.

Objective

To examine the association between the presence and strength of a usual source of care with mortality and readmission after hospitalization for acute myocardial infarction (AMI).

Design

Prospective Registry Evaluating Myocardial Infarction: Event and Recovery (PREMIER), an observational, 19-center study.

Patients

AMI patients discharged between January 2003 and June 2004.

Main Measures

The strength of the usual source of care was categorized as none, weak, or strong based upon the duration and familiarity of the relationship. Main outcome measures were readmissions and mortality at 6 months and 12 months post-AMI, examined in multivariable analysis adjusting for socio-demographic characteristics, access and barriers to care, financial status, baseline risk factors, and AMI severity.

Key Results

Among 2,454 AMI patients, 441 (18.0 %) reported no usual source of care, whereas 247 (10.0 %) and 1,766 (72.0 %) reported weak and strong usual sources of care, respectively. When compared with a strong usual source of care, adults with no usual source of care had higher 6-month mortality rates [adjusted hazard ratio (aHR) = 3.15, 95 % CI, 1.79–5.52; p < 0.001] and 12-month mortality rates (aHR = 1.92, 95 % CI, 1.19–3.12; p = 0.01); adults with a weak usual source of care trended toward higher mortality at 6 months (aHR = 1.95, 95 % CI, 0.98–3.88; p = 0.06), but not 12 months (p = 0.23). We found no association between the usual source of care and readmissions.

Conclusions

Adults with no or weak usual sources of care have an increased risk for mortality following AMI, but not for readmission.

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Acknowledgments

Contributors

None.

Funders

We gratefully acknowledge support from the grant U01-HL105270-03 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute. Dr. Krumholz was supported by grant U01 HL105270-03 (Center for Cardiovascular Outcomes Research at Yale University) from the National Heart, Lung, and Blood Institute. Dr. Ross is supported by the National Institute on Aging (K08 AG032886) and by the American Federation for Aging Research through the Paul B. Beeson Career Development Award Program. CV Therapeutics and CV Outcomes, a 501(c)(3) corporation funded the PREMIER registry.

Prior Presentations

American Heart Association: Quality of Care and Outcomes Research, Poster Presentation, 2011.

Conflict of Interests

Drs. Krumholz and Ross work under contract with the Centers for Medicare & Medicaid Services to develop and maintain performance measures and are the recipients of a research grant from Medtronic, Inc., through Yale University. Dr. Krumholz is chair of a cardiac scientific advisory board for UnitedHealth, and Dr. Ross is a member of a scientific advisory board for FAIR Health. Dr. Spertus reports funding from NIH, AHA, ACCF, Gilead, Genentech, Amorcyte, Eli Lilly and Abbott Vascular. He serves as a consultant to United Healthcare, Genentech, Gilead, Novartis, Janssen, and Amgen.

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Authors and Affiliations

  1. Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA

    Erica S. Spatz MD, MHS & Harlan M. Krumholz MD, SM

  2. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA

    Erica S. Spatz MD, MHS, Mayur M. Desai PhD, MPH, Harlan M. Krumholz MD, SM & Joseph S. Ross MD, MHS

  3. Department of Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Sameer D. Sheth MD

  4. Department of Cardiology, Mid America Heart Institute of St. Luke’s Hospital, Kansas City, MO, USA

    Kensey L. Gosch MS & John A. Spertus MD, MPH

  5. Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA

    Mayur M. Desai PhD, MPH & Harlan M. Krumholz MD, SM

  6. Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA

    Mayur M. Desai PhD, MPH

  7. Department of Cardiology, University of Missouri-Kansas City, Kansas City, MO, USA

    John A. Spertus MD, MPH

  8. Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA

    Harlan M. Krumholz MD, SM

  9. Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA

    Joseph S. Ross MD, MHS

  10. Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation, Yale University School of Medicine/Yale-New Haven Hospital, One Church Street, Suite 200, New Haven, CT, 06510, USA

    Erica S. Spatz MD, MHS

Authors
  1. Erica S. Spatz MD, MHS
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  2. Sameer D. Sheth MD
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  3. Kensey L. Gosch MS
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  5. John A. Spertus MD, MPH
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  6. Harlan M. Krumholz MD, SM
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  7. Joseph S. Ross MD, MHS
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Corresponding author

Correspondence to Erica S. Spatz MD, MHS.

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Spatz, E.S., Sheth, S.D., Gosch, K.L. et al. Usual Source of Care and Outcomes Following Acute Myocardial Infarction. J GEN INTERN MED 29, 862–869 (2014). https://doi.org/10.1007/s11606-014-2794-0

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  • DOI: https://doi.org/10.1007/s11606-014-2794-0

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