economics Paradigm Challenge

Big fancy university hospitals don't actually give you a better chance of surviving heart failure than your local clinic.

March 23, 2026

Original Paper

Association of Hospital Teaching Status and In-Hospital Mortality in Acute Heart Failure Admissions: A Propensity-Matched Analysis, United States 2022

Majed Sheikh, Shruthi Karthikeyan, Jennifer Bolyard, Lakshmi Potakamuri, Abdallah Masri, Hassan Mehmood Lak, Michael Lauer, Amanda Vest, Pei Jun Zhao

SSRN · 6387718

The Takeaway

Patients often travel further and pay a premium to be treated at elite academic medical centers, assuming they offer superior odds of survival. This study of over 65,000 cases shows that once you account for the fact that these hospitals take on sicker patients, their mortality rates are statistically no better than those of smaller, local institutions.

From the abstract

BackgroundAcute heart failure (AHF) hospitalization remains a critical event associated with poor prognosis and high resource utilization. In 2022, age- and sex-standardized cardiac mortality rates in the United States were approximately 17% higher than expected. Whether institutional teaching status independently confers a survival advantage for AHF in contemporary all-payer data remains uncertain.ObjectivesTo evaluate the association between hospital teaching status (Major Teaching, Minor Teac