Following Heart Disease Guidelines Saves Lives

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Consistent implementation of proven Heart Disease guidelines can save lives, according to a Kaiser Permanente (KP) abstract, published this week at the American Heart Association Scientific Sessions in Orlando, Florida.

The researchers followed 598 patients with Acute Coronary Syndromes (ACS) admitted to Kaiser Permanente emergency departments in Northern California and examined whether they received any of six key interventions included in American College of Cardiology/American Heart Association Guidelines that are known to decrease deaths from ACS. The results were then compared with data for ACS patients admitted to non-KP emergency departments, gathered by the National Registry of Myocardial Infarction (NRMI) and CRUSADE.

Overall, more Kaiser Permanente patients received the recommended therapies in every case. For example, 92 per cent of Kaiser Permanente patients with ACS were discharged with an ACE inhibitor or angiotensin-receptor blocker (ARB), recommended in the guidelines as an effective therapy for reducing mortality from heart attacks. By comparison, only 61 per cent of eligible patients in non-KP hospitals in the CRUSADE database and 55 per cent in the NRMI database received an ACE inhibitor or ARB. On admission, 97 per cent of eligible KP patients received beta blockers compared with 74 per cent in NRMI.

Kaiser Permanente Northern California has been systematically implementing the National Clinical Guidelines since the 1990s. Study co-author Eleanor Levin, MD explained that cardiologists and emergency physicians used the guidelines to develop protocols and standardized admit and discharge orders for treating ACS patients.

"Following the guidelines in KP Northern California has been so successful because four departments -- cardiology, quality, emergency medicine, and hospital-based specialists -- have worked closely together to implement protocols and orders for heart disease patients," said Dr. Levin. "We can achieve that kind of effective collaboration because we are an integrated health care organization. Our patients benefited immediately in a very real way -- the number of deaths caused by heart disease among KP Northern California members has been falling consistently since 1995. We hope that these results will encourage other health care organizations to improve implementation of the clinical guidelines and save lives," she said.

The six key therapies and interventions recommended by the National Clinical Guidelines are:

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Once ACS is confirmed in the ED, the following medications should be given:

1. Aspirin, and

2. Beta Blockers

On discharge, patients should receive:

3. Aspirin

4. Beta Blockers, and

5. An ACE inhibitor or ARB and,

6. Advice on quitting smoking for patients who are smokers

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