News Release

Heart treatment gap closes with standardized care

Peer-Reviewed Publication

American Heart Association

Abstract 1

American Heart Association meeting report: Heart treatment gap closes with standardized care WASHINGTON, Oct. 1 – A pilot in-hospital program helped close a treatment gap in heart disease prevention by significantly increasing the number of heart attack patients who followed American Heart Association secondary prevention guidelines.

The number of individuals receiving standardized care for heart disease – including drugs to lower cholesterol and blood pressure, smoking cessation counseling, and referrals to physical activity programs – improved notably over nine to 12 months with the implementation of an American Heart Association in-hospital program, called Get With The GuidelinesSM.

Results of a study of the association’s program were presented today at the American Heart Association’s 3rd Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.

Underscoring the need for the program, recent reports found that doctors and hospitals were not following guidelines aimed at preventing second heart attacks. In a 1999 Journal of the American Medical Association article, research found only half of the eligible candidates received beta-blockers, slightly more than half received ACE inhibitors and only two-thirds were treated with clot busters. In a 1999 Journal of the American Medical Association article, researchers stated that doctors and hospitals were not following guidelines to prevent second heart attacks. That research found only half of the eligible

This treatment gap may be a contributing factor in many recurrent heart attacks and other cardiovascular events. According to American Heart Association statistics, within six years after a recognized heart attack, 18 percent of men and 35 percent of women will have another heart attack, and about 22 percent of men and 46 percent of women will be disabled with heart failure.

As part of the program, hospitals focus on ongoing data measurement and rapid improvement cycles using a Web-based, real-time patient management tool. The tool provides hospitals with immediate access to the guidelines customized for each patient to reduce risk factors.

"This Get With The Guidelines’ tool makes it easy for doctors to make sure each coronary heart patient is treated by these proven therapies," says Kenneth LaBresh, M.D., clinical associate professor of medicine, Brown University in Boston and associate medical director, Massachusetts Peer Review Organization, Inc. "With a few mouse clicks and just 90 seconds, a healthcare provider can be assured the patient doesn’t fall into the treatment gap."

The study tracked the treatment of 1,681 coronary heart disease patients in 22 New England area hospitals. Eighty-one percent of individuals in the study had suffered a heart attack, while others had been treated for chest pain, congestive heart failure or coronary heart disease. Adherence rates were compared in eight risk-reduction measures, such as receiving cholesterol and blood pressure lowering drugs, smoking cessation counseling and referrals to rehabilitation or physical activity programs prior to being discharged from the hospital. The measurements were compared at baseline, four to six months later and nine to 12 months later. LaBresh noted significant improvements by nine to 12 months.

Prior to the program only 48 percent of coronary heart patients were receiving smoking cessation counseling before discharge. After nine-12 months of the program, 81 percent of patients in the hospitals received advice on how to quit smoking.

"For smokers who quit, the risk of subsequent events is cut in half. The first step in this process is to begin counseling prior to discharge from the hospital," says LaBresh. "Despite the fact that smoking cessation and cholesterol treatment have the largest impact on subsequent risk, these are the areas where the largest gaps exist both in New England and around the country."

The number of patients prescribed lipid-lowering drugs such as statins before discharge also improved from 54 percent at baseline to 78 percent by the nine to 12 month point – more than twice national average.

The percent of patients referred for rehabilitation or physical activity programs grew from 33 percent to 70 percent of patients by the year-end.

The percentage of patients with well-controlled blood pressure at discharge rose from 61 percent to 77 percent. Use of ACE inhibitors, beta-blockers and aspirin at discharge in eligible patients was consistently high in the New England area hospital – 82 percent to 90 percent at all measurements. This is well above the national average.

"We were pleased to see that hospitals were able to maintain their high level of performance in these areas, while improving performance in areas where there was substantial opportunity to close the gap. This is the essence of good continuous quality improvement," he notes.

Get With The Guidelines originally mobilized teams in acute-care hospitals to implement the 1995 American Heart Association secondary prevention guidelines for patients with coronary heart diseases, which were endorsed by the American College of Cardiology. The program has been updated to meet the revised American Heart Association/American College of Cardiology secondary prevention guidelines issued in September 2001. It advocates using quality-improvement measures such as care maps, discharge protocols, standing orders and measurement tools based on the secondary prevention guidelines. The program is being introduced in hospitals across the country through continuing medical education workshops and Web-based tools.

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For more the information, visit www.americanheart.org.

CONTACT:
Suzanne Grant: 214-706-1467


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