At last year's ACC meeting, Eagle and his colleagues reported that the GAP project resulted in a 25 percent lower risk of dying within a year of leaving the hospital among heart attack patients whose doctors and nurses followed standard national guidelines for their care, and used the discharge tool and contract. This major effect on mortality rates was the first evidence that standardized heart care saves lives.
GAP tries to increase hospitals' use of aspirin and beta blocker drugs, and cholesterol testing, within 24 hours of a heart attack, and the prescribing of aspirin, beta blockers, cholesterol-lowering drugs and ACE inhibitor drugs for patients leaving the hospital. It also seeks to increase the number of patients who get counseling about diet and smoking before they leave the hospital.
Sandeep Jani, MPH, the researcher who will present the results, notes that on the whole, men treated after the quality effort were more likely to receive pre-discharge prescriptions for all four classes of recommended heart medications than were women. The quality effort significantly improved the use of only two of the drugs beta blockers and aspirin -- in women. Jani is a former ACC intern and research assistant with the GAP project at U-M, and is now studying at the Wayne State University Medical School in Detroit.
The new analysis showing differences in the delivery of care to women and men, even after the quality improvement effort, raises an important question of how hospitals implement quality measures.
Although the new data do not give insights into the factors that caused the gender difference, Jani and Eagle note that the female patients were on average older and more seriously ill, with more co-existing health problems, than the male patients. This fits the known pattern of heart disease among women, who tend to develop the condition and its effects later in life. Cardiovascular disease is the numbe
Contact: Kara Gavin
University of Michigan Health System