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Setting National Hospital Standards Could Boost Cardiac Care

By Jenifer Goodwin
HealthDay Reporter

FRIDAY, Nov. 12 (HealthDay News) -- Around the nation, hospitals refer to themselves as "stroke centers of excellence" or "chest pain centers," the implication being those facilities offer top-notch care for stroke and heart attacks.

But current programs for certifying, accrediting or recognizing hospitals as providers of the best cardiovascular or stroke care are falling short, according to an American Heart Association/American Stroke Association advisory.

"Right now, it's not always clear what is just a marketing term and what actually truly distinguishes the quality of a center," said Dr. Gregg Fonarow, an American Heart Association spokesman and professor of cardiovascular medicine at the University of California, Los Angeles.

A review of the available data found no clear relationship between having a special designation as a heart attack or stroke care center and the care the hospitals provide or, even more important, how patients fare.

To change that, the American Heart Association and the American Stroke Association are jointly developing a comprehensive stroke and cardiovascular care certification program that should serve as a national standard.

The goal is to help patients, insurers and others have more reliable information about where they are most likely to receive the most up-to-date, evidence-based care available, Fonarow said.

"There is a value to having a trusted source develop a certification program that clinicians, insurers and the public can use to understand which hospitals are providing exceptional cardiovascular and stroke care, including achieving high-quality outcomes," he added.

The program, which will take about two years to develop and will likely be done in partnership with other major medical organizations, will cover emergency situations such as heart attack and stroke, but also heart failure management and coronary bypass surgery, Fonarow said.

The advisory is published online Nov. 12 and in the Dec. 7 print issue of Circulation.

Typically, recognition and certification programs require that hospitals put certain procedures in place, but they don't monitor how well hospitals are adhering to the practices or whether patient outcomes are improving, said Fonarow, lead author of the advisory.

And those are the better certification programs. Other self-proclaimed "centers of excellence" may simply be terms dreamed up by marketing departments.

A review of the evidence about the impact of various recognition and certification programs on patient outcomes was mixed, he said. For example, since 2003 the Society of Chest Pain Centers has offered accreditation to hospitals that meet certain quality of care criteria for heart attack patients.

But a study found that on average, accredited hospitals were only adhering to evidence-based guidelines on two of five measures, according to background information in the article. And there was no difference in mortality rates.

Because cardiovascular disease and stroke are major causes of death and disability in the United States, improved care through comprehensive accreditation is badly needed, Fonarow said.

It's widely recognized that if you have a stroke or a heart attack, the quality of care you'll receive varies widely from hospital to hospital.

Some hospitals have 24-hour a day catheterization labs for treating a deadly type of heart attack (ST-segment elevation myocardial infarction, or STEMI), and many have different policies governing when and whether they give the recommended medicine after stroke, among other variables.

"The quality of care being provided and the outcomes achieved by hospitals can determine whether you are going to live or die from the heart attack or stroke or be severely disabled," Fonarow said. "And that may depend on which center you get taken to."

Dr. Clifford Kavinsky, an interventional cardiologist at Rush University Medical Center in Chicago, said a national certification program is sorely needed.

"As technology and medicine advances, and we become more cognizant of the importance of timely care -- particularly for patients with acute stroke and heart attack, where minutes count -- you want to make sure that the hospitals where ambulances take the patients are equipped to provide the treatments necessary for these patients," Kavinsky said. "For that reason, it's important hospitals have accreditation and certification in doing these kinds of advanced treatments."

Measuring hospital performance and patient outcomes, however, is a major undertaking, Kavinsky said.

"To do so is a very large task requiring manpower and expense," Kavinsky said. "Who is going to pay for it? There has to be some incentive for hospitals, whether it's insurance reimbursement or reputation and recognition that brings them more business."

The certification program will likely build upon the American Heart Association/American Stroke Association's Get With the Guidelines program, which encourages hospitals to adopt procedures for resuscitation, stroke and heart failure based on the most recent guidelines for optimal care.

More information

The American Heart Association's Get With the Guidelines program has more on its recommendations for stroke and heart attack care.

SOURCES: Gregg C. Fonarow, M.D., spokesman, American Heart Association, and professor, cardiovascular medicine, University of California, Los Angeles; Clifford Kavinsky, M.D., interventional cardiologist, Rush University Medical Center, Chicago; Nov. 12. 2010, Circulation, online

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