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In terms of prevention, they monitored the percentage of discharged patients who received anticoagulation for atrial fibrillation; treatment with aspirin-like drugs or anticoagulants; cholesterol measurement; treatment for low-density lipoprotein (LDL) cholesterol levels of 100 or higher, or continued therapy for those already on cholesterol-lowering drugs; medications to control diabetes; counseling/drug therapy for smoking cessation; and recommendations for lifestyle changes to control obesity.

Clinically meaningful and statistically significant improvement occurred in all these areas. Certain aspects of care, such as providing treatment with aspirin-like drugs or anticoagulants, had a high baseline compliance (90.7 percent) and continued to improve by the fourth quarter (97 percent). Others, such as treatment with tPA, had low baseline compliance (32.3 percent) and improved substantially (61.1 percent).

"Our data suggest a broad range of baseline rates of compliance on these measures, and there are abundant opportunities for improvement," Schwamm said. "We would consider many of these measures routine and expect them to be performed in all patients. These data provide evidence that system change improves hospital-based compliance with these acute treatment and secondary prevention strategies."

LaBresh added: "The ability of our hospitals to significantly improve the use of secondary prevention measures is particularly exciting because these measures apply to a broad range of patients. Their use will help prevent future strokes and cardiovascular events and are most effective when started in the hospital."

The second study, led by Schwa
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Contact: Carole Bullock
carole.bullock@heart.org
214-706-1279
American Heart Association
2-Feb-2005