U.S. Hospitals Improving Speed, Quality of Heart-Attack Care
Hospitals in the U.S. are delivering faster emergency care to heart-attack patients, increasing their survival, an analysis found.
In 2009, 88 percent of patients with the most urgent kind of heart attacks received artery-clearing procedures within the recommended 90 minutes of arriving at the hospital, compared with 64.5 percent in 2007, the study found. The hospitals performed angioplasty and inserted stents for the emergency patients, and for others prescribed recommended drugs to reduce deaths and complications, according to the research published in tomorrow’s Journal of the American College of Cardiology.
The analysis showed how hospitals can meet benchmarks for improving heart-attack care and adhere to medical guidelines, said study author Christopher Cannon. The report may be issued yearly to detail the progress being made in patient care, he said.
“This provides direct evidence that our efforts are working,” said Cannon, a cardiologist at Brigham and Women’s hospital in Boston and past chairman of the American College of Cardiology’s heart attack registry, in a July 9 telephone interview. “The notion of measuring how we’re doing and trying to do even better pays off. That is likely the way health care will improve over the coming decade, more of this measure and improve as an approach.”
Within an Hour
This year, about 770,000 Americans will have their first heart attack, where blood flow to the organ is suddenly cut off or reduced, and about 430,000 will have a recurrent attack, according to the American College of Cardiology. About 38 percent of those heart attacks will result in death. Half of those deaths occur within one hour of symptoms occurring.
Researchers in the study used guidelines for heart-attack care from the cardiology group and the American Heart Association to measure how well hospitals were meeting these benchmarks.
The study analyzed data from a national registry that included almost 132,000 patients treated for heart attacks at about 250 hospitals from January 2007 to June 2009.
They looked at patients with two kinds of heart attacks. Those called STEMI, for ST segment elevation myocardial infarction, usually have 100 percent blockage of an artery and need urgent care within 90 minutes of a heart attack occurring to open the blockage, Cannon said. Those with a NSTEMI or non- STEMI heart attack, which are almost two times more common, usually have less blockage and don’t need emergency treatment to unclog the artery, he said.
Lower Death Rate
The study also showed that hospital death rates among those patients with a STEMI heart attack fell to 5.5 percent in 2009 from 6.2 percent in 2007. For those with NSTEMI, the death rate fell to 3.9 percent from 4.3 percent.
“It’s wonderful news,” Cannon said. “The sooner you get the artery, the less damage you get to the heart and the better chance you have to survive. That became the biggest quality improvement initiative in cardiology in the last several years.”
More of the hospitals in the study also followed guidelines for prescribing medicines to give patients aspirin or cholesterol-lowering drugs including Lipitor from New York-based Pfizer Inc., Zocor from Whitehouse Station, New Jersey-based Merck & Co. and Crestor from London-based AstraZeneca Plc. Patients also received counseling to stop smoking.
“This study shows that as a country, we do a good job in treating patients with heart attack,” said study author John Rumsfeld, chair of the National Cardiovascular Data Registry and acting national director of cardiology for the Veterans Affairs Health Administration, in a statement.
The researchers also looked at a second database on 1.71 million people who had either angioplasty or heart catheterization from January 2005 to June 2009. They found a reduction in complications related to bleeding or injury to the arteries that are used to pass tubes into the heart. They also found improved use of drugs to prevent blood clots.