Indicator Metadata
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Name |
30-Day Acute Myocardial Infarction In-Hospital Mortality |
Short/Other Names |
Not applicable |
Description |
The risk-adjusted rate of all-cause in-hospital death occurring within 30 days of first admission with a diagnosis of acute myocardial infarction (AMI) For further details, please see the General Methodology Notes (PDF). |
Interpretation |
Lower rates are desirable. |
HSP Framework Dimension |
Health System Outputs: Appropriate and effective |
Areas of Need |
Getting Better |
Geographic Coverage |
All provinces/territories |
Reporting Level/Disaggregation |
National, Province/Territory, Region |
Indicator Results |
Name |
30-Day Acute Myocardial Infarction In-Hospital Mortality |
Short/Other Names |
Not applicable |
Description |
The risk-adjusted rate of all-cause in-hospital death occurring within 30 days of first admission with a diagnosis of acute myocardial infarction (AMI) For further details, please see the General Methodology Notes (PDF). |
Calculation: Description |
The risk-adjusted mortality rate (RAMR) is calculated by dividing the observed number of in-hospital deaths by the expected number of in-hospital deaths and multiplying by the Canadian average in-hospital death rate. Unit of analysis for denominator cases: Episode of care |
Calculation: Geographic Assignment |
Place of residence or service |
Calculation: Type of Measurement |
Rate - per 100 |
Calculation: Adjustment Applied |
The following covariates are used in risk adjustment: |
Calculation: Method of Adjustment |
Logistic regression |
Denominator |
Description: Inclusions:
Note Exclusions:
Note |
Numerator |
Description: Inclusions:
Note Exclusions:
|
Rationale |
A lower risk-adjusted mortality rate following AMI may be related to quality of care or other factors. It has been shown that the 30-day in-hospital mortality rate is highly correlated (r = 0.9) with total mortality (death in and out of hospital) following AMI. Variations in 30-day in-hospital mortality rates may be due to jurisdictional and institutional differences in care practices, as well as to other factors that were not included in the adjustment. |
Interpretation |
Lower rates are desirable. |
HSP Framework Dimension |
Health System Outputs: Appropriate and effective |
Areas of Need |
Getting Better |
Targets/Benchmarks |
Not applicable |
References |
Hosmer DW, Lemeshow S. Confidence Interval Estimates of an Index of Quality Performance Based on Logistic Regression Models. Stat Med 1995;(14):2161-2172. Tu JV, Austin P, Naylor CD, Iron, K, Zhang H. Acute Myocardial Infarction Outcomes in Ontario (Methods Appendix). Cardiovascular Health & Services in Ontario: An ICES Atlas (Technical and Methods Appendices). Eds. Naylor CD and Slaughter PM. Toronto, ON; Institute for Clinical Evaluative Sciences:1999. |
Data Sources |
DAD, HMDB, NACRS |
Available Data Years |
Type of Year: |
Geographic Coverage |
All provinces/territories |
Reporting Level/Disaggregation |
National, Province/Territory, Region |
Update Frequency |
Every year |
Indicator Results |
Web Tool: |
Updates |
Beginning with the 2004 rates, AMI case selection criteria were revised to account for the fact that an increasing number of AMI patients are undergoing revascularization procedure (percutaneous coronary intervention or coronary artery bypass) at their index admission. In the case of revascularization procedure, AMI may not be coded as the most responsible diagnosis, and these cases were previously excluded from the indicator. In addition, exclusion criteria were revised and patients with a length of stay of less than three days and discharged alive are no longer excluded. Prior to 2018–2019, indicator results by place of residence are based on 3 years of pooled data. Starting in 2018–2019, indicator results by place of residence are based on 1 year of data. Due to this change in reporting, trends over time should be interpreted with caution. |
Caveats and Limitations |
Not applicable |
Trending Issues |
Please refer to the Updates section for information on trending. |
Comments |
Prior to 2018–2019, indicator results by place of residence are based on 3 years of pooled data. Starting in 2018–2019, indicator results by place of residence and place of service are both based on 1 year of data. Indicator results by place of service are also available on our Health indicator reporting page (click Additional Acute Care Indicators). |