Emergency Treatment Strategies, Better Communication Among Health Care Workers Reduce Heart Attack Patient Deaths by 19 Percent, Says AHJ Published Study

WILMINGTON, Del., Feb. 10 /PRNewswire/ — Four western New York hospitals
using emergency treatment strategies emphasizing evidence-based therapy and
better communication among health care providers reduced heart attack patient
deaths by 19 percent for up to one year after patient discharge.

The prospective research study, “Acute Coronary Syndrome Emergency
Treatment Strategies: Improved Treatment and Reduced Mortality in Patients
with Acute Coronary Syndrome Using Guideline-based Critical Care Pathways,”
was published in January in the American Heart Journal.

“The study shows that when you improve communication among departments
about patient care, and when you take key information from published medical
journals and apply them to every day medicine, you can make a significant
difference in patient outcomes and the quality of care they receive,” said
study lead author and practicing cardiologist Dr. John Corbelli, who also
serves as associate clinical professor of medicine for the State University of
New York at Buffalo School of Medicine and Biomedical Sciences.

This is the first study to investigate an acute coronary syndrome critical
care pathway approach in a population of patients encompassing the total acute
coronary syndrome management spectrum. WellPoint subsidiary, HealthCore Inc.,
performed the outcomes research for this study based on research funding from
Sanofi-Aventis, Bristol-Myers Squibb and the Kaleida Health Foundation.

“ACSETS was derived from the synergy between the cardiologists and
emergency department physicians,” said Dr. Dave Janicke, study co-author and
clinical associate professor of emergency medicine at State University of New
York at Buffalo School of Medicine and Biomedical Sciences. “The ACSETS
guideline-driving pathway is initiated as soon as the ACS patient arrives in
the Emergency Department and is subsequently carried through hospitalization
including discharge medications and follow-up.”

The prospective study demonstrated that patients received better care for
acute coronary syndrome, including fewer days in the hospital and more
medically appropriate use of medication, when the ACSETS critical care pathway
was used. The control group was made up of patients who had been treated at
the four hospitals before ACSETS was implemented.

“Previous work has established that hospitals adhering to certain
performance measures in treating patients with heart attack had lower
mortality,” said Corbelli. “We wanted to know if we could improve the
mortality rates of these patients by developing a new approach — or a new
critical pathway — to better assist medical staff in putting these published
guidelines into practice.”

Within the first 24 hours after arrival in the emergency department, at
discharge and during 12 months following discharge, more ACSETS patients than
pre-ACSETS patients received all eight guideline-based acute coronary syndrome
treatment medications studied.

“Post discharge readmission and mortality has been shown to be a major
issue in managing patients with ACS,” said Mark Cziraky, study co-author and
HealthCore vice president of research development and operations. “The fact
that the mortality rate is lower one year after discharge in ACS patients
demonstrates that they continued their therapy after leaving the hospital.”

At discharge, ACSETS patients had their medications reviewed so that the
appropriate drug therapies were prescribed. Patients were educated to
understand the impact of their medications and the importance of compliance
with the prescribed regimen. Study authors also met with local managed care
groups to ensure that the design of their health plans allowed ACSETS patients
easy access to cardiac therapies.

While the study showed no difference in in-patient mortality rates among
the two groups, it did show that the ACSETS patients admitted for heart attack
had a mortality rate of 19 percent less than the control group for up to one
year after discharge.

“After discharge, higher refill rates were seen for the ACSETS group than
for the pre-ACSETS group, with that difference showing statistical
significance for clopidogrel and statins,” Cziraky said.

ACSETS, based on guidelines established by the American College of
Cardiology and the American Heart Association, uses pre-printed order sheets
customized for use in the emergency department, inpatient and discharge that
simply the task of matching intensity of therapy to risk. Rather than follow
the normal procedure of creating a new order sheet at every patient stop –
from the ER to the floor and then to discharge — the same set of orders
stayed with the patients as they made their journeys through the hospital.

Physicians and other medical staff members were trained on the ACSETS
order sheets for a period over 26 weeks before the study began. ACSETS
educates medical staff members throughout the continuum of patient care
regarding key elements of the guidelines and encourages ready adherence to
those guidelines at the bedside in a time-efficient manner.

About the study

ACSETS is used for the treatment of acute coronary syndrome patients with
unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), or
ST-elevation myocardial infarction (STEMI). The study group included 1,709
ACSETS patients and 1,240 pre-ACSETS control patients.

The study compares acute coronary syndrome care pre (Jan. 2, 2002) and
post (May 1, 2003 to Aug. 31, 2004) in a four-hospital system in western New
York state. Two hospitals were urban with cardiac catherization facilities and
two other hospitals were suburban and lacked cardiac catherization facilities.

All patients were admitted to the hospital through the emergency
department and discharged with a diagnosis of unstable angina, NSTEMI or
STEMI. The intervention group consisted of patients with at least one ACSETS
order sheet in their medical chart.

About HealthCore

HealthCore, based in Wilmington, Del., is the clinical outcomes research
subsidiary of WellPoint. HealthCore has a team of highly experienced
researchers including physicians, biostatisticians, pharmacists,
epidemiologists, health economists and other scientists who study the “real
world” safety and effectiveness of drugs, medical devices and care management
interventions. HealthCore offers insight on how to best use this data and
communicates these findings to health care decision-makers to support
evidence-based medicine, product development decisions, safety monitoring,
coverage decisions, process improvement and overall cost-effective health
care. For more information, go to www.healthcore.com.

SOURCE HealthCore