Hospital adherence to heart attack guidelines saves lives

AORN Journal, Sept, 2006

Hospitals that follow national guidelines for treating patients with potential heart attacks have lower patient mortality rates, according to an April 26, 2006, news release from Duke University Medical Center News, Durham, NC. Researchers analyzed the records of 64,775 patients at 350 US hospitals and compared the mortality rates for patients who arrive at a hospital with symptoms of a possible heart attack. The study found that hospitals that were the best at following guidelines for nine treatments recommended by the American College of Cardiology and the American Heart Association for patients with possible heart attacks had a mortality rate of 4.15% compared to a mortality rate of 6.31% for hospitals that were the worst at following these guidelines. In addition, every 10% improvement in guideline adherence led to a 10% decline in mortality.

The nine treatments are recommended for the optimal care of patients who present with heart attack symptoms such as chest pain (ie, unstable angina), irregular electrocardiograph readings, or elevated chemical markers of cell death. The guidelines focus on giving patients with suspected heart attacks antiplatelet medications, heparin, glycoprotein IIb/IIIa inhibitors, or beta blockers within the first 24 hours of admission and prescribing medications such as aspirin, beta blockers, angiotensin converting enzyme (ACE) inhibitors, or statins after discharge.

The researchers found that overall, the recommended therapies were used only 74% of the time, but there was a wide variance among hospitals regarding adherence to the guidelines. For example, some hospitals were near perfect in the use of certain medications for patients with suspected heart attacks, but other hospitals administered the medications only 50% to 60% of the time. The researchers also found that hospitals that were more likely to use newer recommended therapies, such as glycoprotein IIb/IIIa inhibitors, clopidogrel, and lipid-lowering medications, had better patient outcomes than hospitals that treated patients only with more established therapies, such as prescribing beta blockers and ACE inhibitors.

Heart Attack Patients Do Better at Hospitals Following Guidelines (news release, Durham, NC: Duke University Medical Center News, April 26, 2006) http://www.duke mednews.duke.edu/news/article.php?id=9634 (accessed 9 Aug 2006).