October 7, 2009 – Hospitals receiving performance awards from the American Heart Association's Get With The Guidelines (GWTG) quality improvement initiative have lower mortality rates for heart attack and heart failure patients than all other hospitals, according to a new study. "Many hospitals enrolled in Get With The Guidelines achieve high levels of recommended care for heart failure, heart attack and stroke," said Paul A. Heidenreich, M.D., M.S., the study lead author and staff physician with the Veteran's Administration Palo Alto Healthcare System in Palo Alto, Calif. "However, prior to this study, it was unclear if actual outcomes are better in those hospitals recognized for high performance by the program." In the study, published in the American Heart Journal, researchers gathered 30-day survival data for all hospitals for heart attack and heart failure, as reported by the Centers for Medicare and Medicaid Services (CMS). They then compared that to the 30-day survival for those conditions reported by award-winning Get With The Guidelines hospitals. Of the 3,909 hospitals represented in the CMS data, 355 received GWTG performance awards for achieving high levels of recommended process of care. Dr. Heidenreich and colleagues found small statistically significant differences in mortality between GWTG performance achievers and all other hospitals. "Some of those differences were explained by the differences in quality of care, with the hospitals that received awards having better quality," he said. The high levels of performance of quality measures at top GWTG hospitals explains 28 percent of the difference between award and nonaward hospitals for heart failure mortality and 43 percent for heart attack mortality, Dr. Heidenreich said. Heart failure mortality for hospitals receiving awards was 11 percent vs. 11.2 percent for all hospitals. For heart attack, or acute myocardial infarction, the mortality at GWTG award-winning hospitals was 16.1 percent vs. 16.5 percent at hospitals without GWTG recognition. "To put this into perspective, even though those appear to be small overall differences in survival, the percentages would lead to an additional 1,800 to 3,500 patients alive at 30 days if all hospitals could achieve the quality of the award-winning hospitals," Dr. Heidenreich said. Furthermore, the study substantiates that GWTG hospitals outperform nonGWTG hospitals, according to Clyde W. Yancy, M.D., president of the American Heart Association and medical director at Baylor Heart and Vascular Institute at Baylor University Medical Center in Dallas. "In those facilities that have a strong approach to quality – to the extent that they have received recognition for that commitment based on a fairly rigorous standard – even seemingly slight improvements can translate to thousands of saved lives," Dr. Yancy said. In future studies, researchers should look at specific parts of the Get With The Guidelines program to determine which of the performance measures are most associated with outcomes, Dr. Heidenreich said. Coauthors of the study are: William R. Lewis, M.D.; Kenneth A. LaBresh, M.D.; Lee H. Schwamm, M.D.; and Gregg C. Fonarow, M.D. Author disclosures are on the manuscript. For more information: www.americanheart.org
AHA Says Get With The Guidelines in Lowering AMI, HF Mortality Rates
Figure 2: Angiography demonstrates a stenotic lesion in the mid right coronary artery, undilatable by standard high-pressure balloon angioplasty (inset, arrowheads). (B) Optical coherence tomography (OCT) cross-sectional (top) and longitudinal (bottom) images acquired before IVL and coregistered to the OCT lens (arrow in A) demonstrate severe near-circumferential calcification (double-headed arrow) in the area of the stenosis. (C) Angiography demonstrates improvement in the area of stenosis after IVL (inset; note the cavitation bubbles generated by IVL [black arrows]). (D) OCT cross-sectional (top) and longitudinal (bottom) images acquired post-IVL and coregistered to the OCT lens (white arrow in C) demonstrate multiple calcium fractures and large acute luminal gain. (E) Angiography demonstrates complete stent expansion with the semicompliant stent balloon (inset) without the need for high-pressure noncompliant balloon inflation. (F) OCT cross-sectional (top) and longitudinal (bottom) images acquired post-stenting and coregistered to the OCT lens (arrow in E) demonstrate further fracture displacement (arrow), with additional increase in the acute area gain (5.17 mm2), resulting in full stent expansion and minimal malapposition.
A macrophage immune cell, with a dead cell (pink) that has been eaten, and a mitochondrion (green) between the dead cell and the nucleus. The study’s findings indicate that what the macrophage eats is taken up by the mitochondrion, which in turn communicates with the nucleus to activate the macrophage to promote tissue repair. Image courtesy of Northwestern Medicine.