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Quality improvement program enhances heart care, closes gender gap
November 9, 2003

ORLANDO, FL (AHA) 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.

Researchers 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 guidelines.

LaBresh, also 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.

Results were 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.

The second 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).

“It’s pretty exciting that this program helped identify gender-related treatment gaps and close them within a year,” Ellrodt said.

Several national efforts measure hospital performance, but those efforts don’t go far enough, LaBresh said.

“What’s really 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.” 

The program 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 implemented nationwide.”

LaBresh’s 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.

Ellrodt’s 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 Guidelines research.

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