Failure-to-Rescue After Acute Myocardial Infarction

Jeffrey H. Silber, Alexander F. Arriaga, Bijan A. Niknam, Alexander S. Hill, Richard N. Ross, Patrick S Romano

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: Failure-to-rescue (FTR), originally developed to study quality of care in surgery, measures an institution’s ability to prevent death after a patient becomes complicated. Objectives: Develop an FTR metric modified to analyze acute myocardial infarction (AMI) outcomes. Research Design: Split-sample design: a random 20% of hospitals to develop FTR definitions, a second 20% to validate test characteristics, and an out-of-sample 60% to validate results. Subjects: Older Medicare beneficiaries admitted to short-term acute-care hospitals for AMI between 2009 and 2011. Measures: Thirty-day mortality and FTR rates, and in-hospital complication rates. Results: The 60% out-of-sample validation included 234,277 patients across 1142 hospitals that admitted at least 50 patients over 2.5 years. In total, 72.1% of patients were defined as Medically Complicated (complex on admission or subsequently developed a complication or died without a recorded complication) of whom 19.3% died. Spearman r between hospital risk-adjusted 30-day mortality and FTR was 0.89 (P<0.0001); Mortality versus Complication=−0.01 (P=0.6198); FTR versus Complication=−0.10 (P=0.0011). Major teaching hospitals displayed 19% lower odds of FTR versus non-teaching hospitals (odds ratio=0.81, P<0.0001), while hospitals as a group defined by teaching hospital status, comprehensive cardiac technology, and having good nursing mix and staffing, displayed a 33% lower odds of FTR (odds ratio=0.67, P<0.0001) versus hospitals without any of these characteristics. Conclusions: A modified FTR metric can be created that has many of the advantageous properties of surgical FTR and can aid in studying the quality of care of AMI admissions.

Original languageEnglish (US)
JournalMedical Care
StateAccepted/In press - Mar 23 2018


  • failure-to-rescue
  • mortality
  • quality of care

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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