Heart Attack, Heart Failure Care Varies Across Nation

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The 30-day mortality (death) and readmission rates for acute care of heart attack and heart failure patients vary significantly from hospital to hospital across the nation, according to a new study published in Circulation: Cardiovascular Quality and Outcomes.

Researchers analyzed findings from the 2009 Centers for Medicare and Medicaid Services (CMS) 30-day outcomes report for acute myocardial infarction (heart attack) and heart failure, part of the CMS Hospital Compare quality initiative.

Researchers reviewed three years of experience (July 2005 to June 2008) of Medicare fee-for-service patients with heart failure and heart attack. Calculating 30-day death and readmission rates, based on nearly 600,000 heart attack admissions and more than 1 million heart failure admissions at almost 5,000 hospitals nationwide, they found:

* The average 30-day death rate for heart attack was 16.6 percent and the average rate of heart attack readmission was 19.9 percent.
* The average 30-day death rate for heart failure was 11.1 percent and 24.4 percent for readmission.

The researchers said their findings represent an opportunity for improvement.

"If we just look at readmission, one in four patients who has heart failure and one in five who has a heart attack is back in the hospital within 30 days for readmission," said Harlan M. Krumholz, M.D., the study's lead author and professor of medicine and outcomes researcher at Yale University School of Medicine in New Haven, Conn. "Variations in those rates from hospital to hospital tell yet another story. What we're seeing is that, for example, for heart attack patients, the best hospital in the country has a 30-day mortality rate of only about 11 percent and the hospital with the highest rate in the country has a rate of almost 25 percent."

Researchers also found:

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* Heart failure death rate ranged from 6.6 percent to 19.8 percent.
* Readmission for heart attack ranged from 15.3 percent to 29.4 percent.
* Readmission for heart failure ranged from 15.9 percent to 34.4 percent.

"This suggests that patients' outcomes are dependent, at least in part, on the hospital that provides their care," Krumholz said. "What we seem to have here are differences among hospitals that are based on quality and the systems that they have in place. If we could better understand how the best hospitals achieve their results and help the hospitals that are not doing as well improve, we could save many more lives."

He said the release and analysis of the CMS data may now make that possible.

"Hospitals, consumers and others can see how individual hospitals are performing when it comes to heart attack and heart failure care," he said. "The hope is that this information will stimulate constructive engagement by the healthcare community to find ways to improve performance and patient outcomes."

"These repeat hospitalizations often happen within 30 days of a prior hospitalization for the same illness and cost CMS and other payers billions of dollars on an annual basis," said Clyde W. Yancy, M.D. president of the American Heart Association and medical director at Baylor Heart and Vascular Institute in Dallas, Texas. "But even while continually increasing our efforts to prevent heart disease, we must improve the quality of care these patients are receiving now."

Treating patients with evidenced-based medicine known to improve health outcomes is the most effective therapy, he said.

"We currently have a robust amount of information now captured in our clinical practice guidelines that truly inform and can guide practitioners in caring for heart attack and heart failure patients," Yancy said. "Quality improvement initiatives such as the suite of the American Heart Association's Get With The Guidelines programs provide a ready solution to help hospitals and healthcare providers follow these guidelines demonstrated to improve care. We know that best outcomes are realized when the best quality of care is provided."

"Hospitals participating in Get With The Guidelines have shown substantial improvements in the use of evidence-based, guideline-recommended therapies for patients with heart attack and patients with heart failure - including those therapies most closely linked to better 30-day clinical outcomes," said Gregg C. Fonarow, M.D., immediate past chair of the Get With The Guidelines Steering Committee and professor of cardiovascular medicine at the University of California Los Angeles.

"However, there are still many hospitals that are not participating in quality improvement programs and, as this new study demonstrates, there remain substantial opportunities to improve care and reduce variation in the clinical outcomes for heart attack and heart failure patients nationwide," Fonarow said.

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