This finding is important they said, because while many studies have proven the effectiveness of individual therapies in improving outcomes for heart attack patients, very few have correlated individual hospitals' use of these different therapies with how their patients actually fare.

For their study, the researchers consulted a database of 64,775 patients at more than 400 U.S. hospitals to determine how hospitals adhered to nine different quality measures of in-hospital and discharge care. Those hospitals in the top 25 percentile of adherence were deemed "leading," while the bottom 25 percent were "lagging."

"We found a large gulf in the outcomes between the two, with a mortality rate of 4.17 percent at the leading hospitals, compared to a 6.33 percent mortality rate at lagging hospitals," said Eric Peterson, M.D., cardiologist at the Duke Clinical Research Institute (DCRI). "This is one of the first studies that has linked adherence to established national guidelines to improved outcomes.

"Encouraging hospitals to systematically monitor the use of recommended therapies is one way to promote quality of care and improve patient outcomes," he added.

Peterson reported the results of the analysis March 10, 2004, at the annual meeting of American College of Cardiology (ACC).

Both the ACC and the American Heart Association have issued guidelines for optimal care of patients who arrive at hospital with symptoms of a possible heart attack, such as chest pain (unstable angina), irregular readings on an electrocardiograph or elevated chemical markers of cell death.

The guidelines were adopted after large-scale clinical trials demonstrated the effectiveness of these therapies in saving lives. The guid
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Contact: Richard Merritt
merri006@mc.duke.edu
919-684-4148
Duke University Medical Center
8-Mar-2004