Hospitals To Follow Heart GuidelinesSM
An Archives of Internal Medicine article published today, “An organized approach to improvement in guideline adherence for acute myocardial infarction,” presented the first head-to-head comparison of quality medical care provided by Get With The GuidelinesSM-Coronary Artery Disease (GWTG-CAD) hospitals vs. other US hospitals not participating in GWTG-CAD. Participation in GWTG was independently associated with improvements in guidelines-based care.
“Despite having a wealth of research providing a solid blueprint for treating cardiovascular disease, gaps, variations, and disparities in the use of evidence based therapies remain,” said Gregg C. Fonarow, M.D., FACC, FAHA, chairman of the Get With the Guidelines Steering Committee. “Get With The Guidelines helps address challenges in guidelines adherence by helping health care providers navigate through the blueprint, giving them a way to track their progress in real time, so patients receive the quality care they should. This study demonstrates that Get With The Guidelines works.”
This study used hospital data from Hospital Compare, an online database created by the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services. It compared eight individual quality-of-care measures and two composite scores in 223 GWTG-CAD hospitals and 3407 non-GWTG-CAD hospitals.
These quality measures included aspirin on admission, aspirin use at discharge, beta-blocker use on admission, beta-blocker use at discharge, ACE inhibitor use at discharge, tobacco cessation counseling at discharge, administration of thrombolytic agents within 30 minutes and PCI within 120 minutes.
The two composite scores include the Hospital Compare score which includes all eight quality measures and the GWTG-CAD composite, which uses four of the eight.
GWTG-CAD hospitals demonstrated better adherence to guidelines in four individual measures: aspirin use at discharge, beta-blocker use at discharge, ACE inhibitor use at discharge and tobacco cessation counseling at discharge.
“With more than one million patients hospitalized with AMI each year, these differences in performance would still translate to tens of thousands of additional patients treated with recommended therapies each year if all U.S. hospitals provided the same level of performance as those of GWTG-CAD hospitals,” said William Lewis, M.D., FACC, GWTG Steering Committee member and lead study author.
Adherence to the overall hospital comparison composite score was 4.7 percent higher in GWTG hospitals compared to non-GWTG hospitals. Adherence to the GWTG-CAD composite score was 6.5 percent higher in GWTG hospitals compared to non-GWTG hospitals.
The American Heart Association launched GWTG in 2000 to support and facilitate the improvement of the quality of care of patients with cardiovascular disease using a web based patient management tool to collect clinical data, provide decision support, and provide real-time online reporting features.
The need for quality improvement programs is well established, with more than eight million adult Americans having had a heart attack and more than 900,000 developing new or recurrent heart attacks each year. At age 40 or older, 18 percent of men and 23 percent of women will die within a year after their first heart attack.