Death rates ranged from 17.6 percent at "lagging" hospitals (those with low guideline adherence) to 11.9 percent among "leading" hospitals (those with the highest overall guideline adherence).

"The study underscores the importance of following clinical practice guidelines to improve patient outcomes," says Eric D. Peterson, M.D., lead author of the study and associate professor of medicine at Duke University School of Medicine in Durham, N.C. "Some physicians balk at being held accountable to guidelines-based medicine, but this study demonstrates that adhering to guidelines saves lives."

Quality measures recommended jointly by the American Heart Association and the American College of Cardiology for emergency heart attack treatment include: clot-busting treatment within 30 minutes of arrival at the hospital; angioplasty within 90 minutes; aspirin within 24 hours; beta-blockers within 24 hours; heparin within 24 hours; and glycoprotein IIb/IIIa inhibitors within 24 hours of admission.

Other recommendations include: aspirin, beta-blockers, ACE inhibitors and cholesterol-lowering therapy prescribed at hospital discharge; blood pressure below 140/90 mm Hg by discharge; smoking cessation counseling; and physical activity counseling (education on or referral to cardiac rehab or outpatient exercise program).

This is one of the first studies to examine how variation in treatment affects patient outcomes, Peterson says. In a hospital, quality-of-care indicators refer to how a patient is treated while ill in the hospital. When treatments are backed by randomized, controlled trial data showing an impact on death rates, they are considered Class I recommendatio
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Contact: Carole Bullock
carole.bullock@heart.org
214-706-1279
American Heart Association
17-Nov-2002