By Howard Gleckman
You just had your annual physical. Your family doctor says he wasn't happy with your EKG and wants to you see a cardiologist for tests.
Before you go, you might want to check out local hospitals to see which are rated the highest for treating heart disease. Why check out the hospitals first? Because doctors may have privileges at just a few facilities in your area, and if you eventually need surgery or other intensive treatment, you want to make sure your cardiologist will do the work at a top-ranked facility. And the best docs are often -- though not always -- affiliated with the best hospitals in their specialty. So find the hospital first, then find an affiliated cardiologist.
Of course, if you think you are having a heart attack, you'll be calling 911, not surfing the Web. But often, heart disease progresses slowly, and you will have plenty of time to do some online research.
Where do you start? While detailed, objective, hospital ratings are still in their infancy, it turns out that heart disease is one illness where the quality of care can be graded. In part that's because there is good data on the benefits of certain treatments. And hospitals that provide such care show better outcomes for cardiac patients than hospitals that don't. For instance, studies have shown that heart failure patients do much better when given drugs called ACE inhibitors or angiotensin II receptor blockers (ARBs), both of which increase blood flow. So hospitals that prescribe them get higher ratings than those they don't.
The federal government provides one easy-to-use resource, operated by the Centers for Medicare & Medicaid Services. Just click on for Hospital Compare, a service that allows you to search local facilities to see how well they treat both heart disease and heart attacks.
Another hint: Hospital Compare also looks at infection rates at hospitals. If you are going to have cardiac surgery, even a relatively minor procedure such as implantation of a pacemaker, take a close look at this measure. Low infection rates are a powerful predictor of hospital quality, and avoiding these nasty bugs should be a top priority for anyone about to be admitted to a hospital.
Another good resource is the Joint Commission on Accreditation of Health Care Organizations, a private, nonprofit organization. JCAHO (pronounced Jayco) sets standards for quality care and patient safety and certifies hospitals, nursing homes, health plans, and other medical care providers.
HANDICAPPING HIGH RISK.
JCAHO's Web site is full of good information, although it isn't easy to navigate. Go to their home page and click on Quality Check. You'll be asked to plug in your Zip Code, and you'll find a link to your local hospitals. From there you can look at an individual facility or compare several. For each hospital, look at how they rate for heart attack care or heart failure care, whichever is appropriate for you.
Another national resource is the Leapfrog Group, a private organization that rates some hospitals around the country. Leapfrog, which is funded by major employers and some insurance companies, rates hospitals on a handful of high-risk procedures, including bypass and other cardiac surgery.
Leapfrog doesn't cover as many hospitals as JCAHO or CMS, in part because it only rates those hospitals that volunteer to respond to its surveys. Hospital Compare, by contrast, uses Medicare claims information and other sources. Leapfrog does provide a somewhat different perspective than the other two sites. Because hospitals that do lots of heart surgeries tend to have the highest success rates, Leapfrog tells you exactly how many are performed at each hospital, and gives you a rating for each procedure.
But Dr. Vince Bufalino, a Naperville (Ill.) cardiologist, warns that consumers need to be careful when they evaluate what they see on the Web sites. For instance, Hospital Compare gives numerical grades and, says Bufalino, patients need to remember that there is no real difference between a hospital that scores 94 and one that scores 92. The sites, he says, "should be one bullet point in your evaluation."
You can also check your health insurance company's Web site. Most now include some guidance for choosing a hospital, although few provide the detail you'll find in Hospital Compare or JCAHO. Some, such as Cigna, use the Leapfrog data. But be aware: Many insurers will rank a hospital in their top tier but won't give you much information about why.
Finally, before you have your surgery, you might want to get more general information on heart disease and its treatment. There are plenty of good Web-based resources, including the American Heart Assn. at and WebMD at . For somewhat more technical, but more detailed information, you can go to the National Institutes of Health site at .
Rating hospitals for heart care is still an imperfect process, and an informed patient may want to know a lot more than they can learn on the Web. But check out these sites before you see that cardiologist. They'll give you a good grounding when you start to ask questions.