Hospitals that don't follow heart attack care guidelines have significantly higher death rates

CHICAGO Heart attack patients treated at hospitals that are less likely to follow established treatment guidelines have almost twice the mortality rate as those treated at hospitals whose practices have been proven effective by clinical trials, Duke Medical Center cardiologists have found.

"The study underscores the importance of following clinical practice guidelines to improve patient outcomes," said Eric Peterson, M.D., who with his colleagues conducted the study. "Some physicians may balk at being held accountable to guidelines-based medicine, but this study demonstrates that adhering to guidelines saves lives."

In their review of more than 250,000 patients who suffered a heart attack in the U.S. in the past two years, Peterson and his colleagues found that the death rate at hospitals that adhere the most to established guidelines have mortality rates of 8.3 percent, compared to 15.3 percent for those hospitals least likely to adhere to the guidelines. The researchers measured how many of the patients died while in the hospital.

Peterson, who presented the results of the analysis today (Nov. 17, 2002) at the 75th annual scientific session of the American Heart Association (AHA), said that theirs is one of the first studies actually demonstrating that following guidelines established by such organizations as the AHA and American College of Cardiology can improve the outcomes for heart attack patients.

For his analysis, Peterson and his colleagues sought to determine how often hospitals followed 15 different guidelines for the immediate and discharge care of heart attack patients. The immediate care guidelines included the use of specific drugs and procedures within the first 24 hours of a heart attack, while the discharge guidelines covered use of medications, smoking cessation and rehabilitation.

In order to determine what effects these actions had on actual patient outcomes, the researchers consulted the National Registr

Contact: Richard Merritt
Duke University Medical Center

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