Using a low-cost,
hospital quality improvement program substantially improved care
for heart attack patients and significantly reduced treatment
differences for men and women in one year, researchers reported
at the American Heart Association’s Scientific Sessions 2003.
The program helped
hospitals improve in basic care such as increasing aspirin use
during a heart attack by nearly 15 percent. The American Heart
Association’s Get With The Guidelines Coronary Artery Disease (GWTG-
CADSM) program helps care teams build systems that
ensure patients receive the best evidence-based medical
treatment before they leave the hospital.
performed two analyses on the database of the first 27,825
patients treated at 123 hospitals across the country. The
program is used in more than 400 hospitals.
One analysis, led
by Kenneth A. LaBresh, M.D., a clinical associate professor of
medicine at Brown University in Providence, R.I., reported
significant improvement in all 10 measures of treatment
quality. Measures are based on the American Heart
Association/American College of Cardiology secondary prevention
director of hospital projects at MassPro, Inc. in Waltham,
Mass., noted that one inexpensive, but effective, treatment –
the early use of aspirin during a heart attack – increased from
75.3 percent at baseline to 89.2 percent. Also, the use of
beta-blockers at the time of heart attack rose from 62 percent
at baseline to 84.7 percent.
impressive for all guidelines. For example, at baseline, only
57.2 percent of patients who smoked received counseling to
quit. The figure rose to 81.6 percent for hospitals that had
used the GWTG-CADSM program for a year.
analysis compared how male and female heart attack patients were
treated in five key secondary prevention areas at hospital
discharge. This study was led by Gray Ellrodt, M.D., chair of
medicine at Berkshire Medical Center in western Massachusetts.
At the start of
the study, women discharged from the hospital were less likely
than men to receive lifesaving therapies, including aspirin,
beta-blockers and cholesterol-lowering drugs.
By the study’s
end, treatment rates for both sexes had risen substantially and
gender differences were significantly reduced for all
interventions except smoking cessation. However the disparity
in smoking cessation rates did not reach statistical
significance, Ellrodt said.
In addition, more
women than men were prescribed beta-blockers (92.4 percent to
90.8 percent) and ACE-inhibitors (69.9 percent to 67.5 percent).
exciting that this program helped identify gender-related
treatment gaps and close them within a year,” Ellrodt said.
efforts measure hospital performance, but those efforts don’t go
far enough, LaBresh said.
important is not only documenting care, but improving it. Get
With The Guidelines-CADSM provides an easy-to-follow
framework in which hospitals can change their systems of care
and improve their performance. And it gives faster feedback
than any other system in place at the moment.”
enhances participating hospitals’ care of heart attack patients
by facilitating collaborative learning sessions,
teleconferences, and the Patient Management Tool (PMT). PMT,
which costs $900 per hospital per year, prompts physicians,
nurses and other care team members to follow American Heart
Association/American College of Cardiology guidelines to reduce
the risk of another cardiac event.
Using a password,
hospital personnel can access the secure Web site from any
device with an Internet connection. There they find checklists
that prompt the caregiver to follow proven treatment options,
including what medications to use and referrals to appropriate
risk modification counseling, such as smoking cessation or
exercise rehabilitation. It also generates treatment guidelines
for patients to take to their primary care doctor.
“It’s like a
safety net,” LaBresh said. “Except this safety net has the
potential to save 80,000 lives a year if the program were
co-authors are Gray Ellrodt, M.D.; Gregg C. Fonarow, M.D.;
Robert O. Bonow, M.D.; Lynn A. Smaha, M.D., Ph.D; Patricia A.
Tyler, R.N.; Warren Skea, Ph.D.; Yuling Hong, M.D., Ph.D.;
Jennifer Emond; and Sidney C. Smith Jr., M.D.
co-authors are Kenneth A. LaBresh, M.D.; Yuling Hong, M.D.,
Ph.D.; and Rose Marie Robertson, M.D.
Merck, Inc. and
the American Heart Association funded the Get With The