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Hospitals Reduce Heart Attack Deaths
Date:8/18/2009

esults lagged behind the outcomes of most others. In the 1990s, heart attack death rates of more than 24 percent were noted at 39 hospitals. In 2006, no U.S. hospital reported such a high rate, and the death rate in the worst 1 percent was 19.5 percent.

Overall, the difference between the results obtained at all hospitals narrowed considerably, from 4.4 percent to 2.9 percent.

Improvement was achieved without coercion, with CMS simply keeping hospitals informed of what could be done, said AHA President Dr. Clyde W. Yancy, director of the Baylor Heart and Vascular Institute in Dallas. This was helped by a legislative mandate requiring hospital reporting of data.

"One of the best strategies to influence behavior is to make a facility or individual physician aware of their own results," Yancy explained. "Medicare was making individual centers aware of their own information."

Other striking changes also occurred during the decade. The average hospital stay for a heart attack decreased by nearly 16 percent, from 7.9 days in 1995 to seven days in 2006. Many more survivors were sent to a skilled nursing facility or intermediate care center instead of straight home -- 9.3 percent in 1995-96 vs. 17.4 percent in 2006.

The focus on improvement also came at a unique time in the history of cardiology, when major advances in heart attack treatment became available, Yancy said.

"There has to be an alignment in the process of care development and the methods used to measure outcome," he said. "You need the best science and the best process of instilling the implementation of these developments."

Because similar medical advances are not being made across the board, the program that improved heart attack treatment results won't necessarily apply to all cardiac patients, Yancy said. Notably, no such improvement has been seen in people hospitalized with heart failure, the progressive loss of ability to pump blood th
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