Guideline adherence important for heart patients
Posted on: Wednesday, 26 April 2006, 07:36 CDT
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.
Source: REUTERS
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