Heart Attack Survival Varies Widely Among Hospitals, Study Finds
Simple changes in administrative procedures can save lives, researchers say
Monday, April 30, 2012
Hospitals that follow five simple strategies -- including good teamwork and having cardiologists on hand 24/7 -- have twice the 30-day survival rates of other medical centers, the study found.
But fewer than 10 percent of the 500-plus U.S. hospitals studied follow even four of the five practices, the study authors said.
"If we could implement all of the strategies across the nation, we would save thousands of lives annually," said lead researcher Elizabeth Bradley, a professor of public health at the Yale School of Public Health in New Haven, Conn. "Relatively simple strategies and a culture that focuses not on hiding problems but on finding and solving problems is the best medicine we can give ourselves."
The strategies include monthly meetings with doctors and paramedics to review heart attack cases; having cardiologists always available; encouraging creative problem solving; specializing nursing duties and better teamwork between doctors and nurses.
Encouraging creative problem-solving and better doctor-nurse teamwork appeared to have the most effect, reducing deaths by 0.84 percent and 0.88 percent respectively. Monthly reviews with doctors and emergency transport personnel lowered deaths by 0.70 percent; keeping heart specialists on site brought deaths down 0.54 percent and using only specialized nurses cut deaths by 0.44 percent.
"These strategies are a mix of concrete processes and the overall culture of the hospital," Bradley said. They are also "relatively inexpensive and do not require a lot of capital investment, but rather reflect how people work with each other."
For the study, published in the May 1 issue of the Annals of Internal Medicine, Bradley's team looked at deaths after heart attacks in 537 hospitals from January 2008 to December 2009.
Fewer than one-quarter of the hospitals held monthly meetings with the paramedics who transported heart attack patients, and only 14 percent had a cardiologist on duty at all times, the study found. Having a pharmacist accompany doctors on medical rounds also improved odds of survival, but just 35 percent of the hospitals studied did so.
Still, while these management strategies were associated with improved survival rates, the authors cautioned that the study cannot establish cause and effect.
Speaking on behalf of the American Heart Association, Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said that "owing to advances in care and performance improvement programs, there have been significant improvements in survival in patients presenting with an acute heart attack."
Nevertheless, there appear to be substantial opportunities to further improve outcomes of these patients, he said.
In this study, certain strategies were found to have statistically significant but small associations with differences in 30-day mortality.
"Additional efforts are needed to implement evidence-based, guideline-recommended therapies in all eligible acute heart attack patients and further promote effective strategies, performance improvement programs and systems of care," Fonarow said.
The American Heart Association and the American College of Cardiology together with the American Heart Association offer highly effective guidelines for hospitals that want to improve care of heart attack patients, he said.
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