MONDAY, July 12 (HealthDay News) -- Patients who have a heart
attack and undergo procedures to open blocked arteries are getting
proven treatments in U.S. hospitals faster and more safely than
ever before, according to the results of a large-scale study.
Data on more than 131,000 heart attack patients treated at about
250 hospitals from January 2007 through June 2009 also showed that
the patients themselves have become more aware of the signs of
heart attack and are showing up at hospitals faster for help.
Lead researcher Dr. Matthew T. Roe, an associate professor of
medicine at Duke University Medical Center and the Duke Clinical
Research Institute, thinks a combination of improved treatment
guidelines and the ability of hospitals to gather data on the
quality of their care accounts for many of the improvements the
"We are in an era of health care reform where we shouldn't be accepting inferior quality of care for any condition," Roe noted.
"Patients should be aware that we are trying to be on the leading edge of making rapid improvements in care and sustaining those," he added. "Patients should also be aware that the U.S. is on the leading front of cardiovascular care worldwide."
The report is published in the July 20 issue of the
Journal of the American College of Cardiology.
Roe's team, using data from two large registry programs of the
American College of Cardiology Foundation's National Cardiovascular
Data Registry, found there were significant improvements in a
number of areas in heart attack care:
- An increase from 90.8 percent to 93.8 percent in the use of
treatments to clear blocked blood vessels.
- An increase from 64.5 percent to 88 percent in the number of
patients given angioplasty within 90 minutes of arriving at the
- An improvement from 89.6 percent to 92.3 percent in performance
scores that measure timeliness and appropriateness of therapy.
- Better prescribing of blood thinners.
- A significant drop in hospital death rates among heart
- Improvement in prescribing necessary medications, including
aspirin, anti-platelet drugs, statins, beta blockers,
angiotensin-converting enzyme inhibitors and angiotensin-receptor
- Improvement in counseling patients to quit smoking and
referring patients to cardiac rehabilitation.
In addition, patients were more aware of the signs of heart
attack and the time from the onset of the attack until patients
arrived at the hospital was cut from an average 1.7 hours to 1.5
hours, the researchers found.
Roe's group also found that for patients undergoing an
- There was an increase in the complexity of the procedure,
including more patients with more challenging conditions.
- There were reductions in complications, including bleeding or
injury to the arteries.
- There were changes in medications to prevent blood clots, which
reflect the results of clinical trials and recommendations in new
clinical practice guidelines.
- And there was a reduction in the use of older drug-eluting
stents, but an increase in the use of new types of drug-eluting
Despite all the good news, Roe's team said there was still room
for improvement in care, particularly in ways to reduce the risk of
bleeding that is present with even the most advanced
"We need to do ongoing and regular surveillance of care patterns" Roe said.
Dr. Gregg C. Fonarow, a cardiology professor at the University
of California, Los Angeles, commented that "national clinical
registries provide valuable data to characterize recent trends in
the treatment and in-hospital clinical outcomes for patients
hospitalized with cardiovascular disease or those undergoing
This new report demonstrates improvements in the speed in which
reperfusion is offered in heart attack patients, better use of
guideline-recommended medications in heart attack patients, and
decreases in complications in patients undergoing coronary
procedures, Fonarow said.
"These findings show the substantial efforts to provide physicians and hospitals with detailed feedback on performance coupled with targeted quality improvement efforts are producing measurable and meaningful benefits to cardiovascular disease patients," Fonarow added.
However, he said, there are further opportunities to improve
care and clinical outcomes for patients with heart attacks and
those undergoing cardiovascular procedures. Because "not all U.S.
hospitals are participating in these voluntary clinical registries,
there is a very important need to expand hospital participation,"
Fonarow noted. Fonarow is the unpaid chair of the Get With The
Guidelines committee of the American College of Cardiology ACTION
For more information on heart attacks, visit the
American Heart Association.