Guideline adherence important for heart patients

NEW YORK (Reuters Health) – There is a strong link between
hospital adherence to treatment guidelines and the outcome of
patients with acute coronary syndromes (ACS), which is
characterized by the initial stages of a heart attack or
cardiac chest pain (also referred to as angina), according to a
new study. Specifically, greater adherence to the guidelines is
associated with improved survival rates in hospitalized ACS
patients.

“Our work supports the central hypothesis of hospital
quality improvement; namely, better adherence with
evidence-based care practices will result in better outcomes
for patients who are treated,” write Dr. Eric Peterson and
colleagues from Duke University Medical Center in Durham, North
Carolina report in the Journal of the American Medical
Association.

The study is based on an analysis of 64,775 ACS patients
treated at 1 or 350 academic and nonacademic medical centers in
the United States. Overall, the 9 treatments recommended by the
American College of Cardiology and American Heart Association
for ACS were followed 74 percent of the time.

This shows that the hospital care delivered to these
patients is not ideal — up to 25 percent of ACS patients do
not received drugs proven to save lives, Peterson noted in a
university statement.

The data also show that there is wide variance among
hospitals — “some are near perfect in the use of certain drugs
while others are in the 50 percent to 60 percent range of
adherence,” he noted.

Specifically, the research team found that hospitals with
the highest levels of adherence to the nine different ACS
treatment guidelines had an in-hospital death rate of 4.15
percent, compared with a rate of 6.31 percent for hospitals
with the lowest levels of adherence.

Additionally, after consideration of other risk factors,
every 10-percent improvement in adherence to ACS treatment
guidelines led to a 10-percent decline in in-hospital deaths.

Adherence to proven guidelines may also be an overall
indication of the quality of a hospital’s care and its
commitment to providing the best care possible, Peterson said.

The team also found that hospitals with high adherence to
ACS treatment guidelines were also more likely to use newer
recommended therapies such as clot-busting and
cholesterol-lowering drugs.

“Again, keeping up with the latest is another indicator of
a hospital’s overall culture of providing the best possible
care,” Peterson said.

SOURCE: Journal of the American Medical Association, April
24, 2006.