Heart attack death rates dropped significantly at hospitals that participated in a quality-improvement process that increased the use of evidence-based therapies, according to a new study in the Oct. 4, 2005, issue of the Journal of the American College of Cardiology.
"This study shows that the Guidelines Applied in Practice Project improves not just process indicators, but also mortality in hospital, and especially at 30 days and a year later," said Kim A. Eagle, M.D., F.A.C.C., from the University of Michigan Cardiovascular Center in Ann Arbor, Michigan.
The Guidelines Applied in Practice (GAP) Project is a collaborative effort to raise the quality of heart attack care. The project is led by the American College of Cardiology and includes a group of Michigan hospitals, health systems and insurers, as well as community stakeholders and coalitions, including major automobile companies and unions. Previous reports from the project showed that a systems approach and tools such as standardized admission and discharge documents and "contracts" between physicians and patients could boost adherence to recommended therapies, including aspirin and ACE inhibitors, as well as smoking cessation and dietary counseling. The use of recommended therapies was higher at GAP hospitals than at similar hospitals that did not participate in the project.
Now the researchers report that the GAP hospitals saw heart attack death rates drop. Deaths in the hospital declined from 13.6 percent to 10.4 percent. At 30 days after hospital discharge, the death rate dropped from 21.6 percent to 16.7 percent. After one year, the death rate declined from 38.3 percent to 33.2 percent. After statistical adjustments for a variety of factors, the authors report that when a standard discharge document was used as recommended, the risk of a patient dying within one year was cut almost in half (1-year mortality, odds ratio 0.53; 95% CI 0.36 to 0.76; p = 0.0006).
"The differences are very real. The absolute reduction in one-year death rates was 5 percent, that is, one additional life saved for every 20 patients treated. And if the hospitals used the standardized tools, the impact looked far greater," Dr. Eagle said.
He said the GAP project helps hospitals, caregivers, and patients to put into practice a variety of lifestyle interventions and medical treatments that have been proven effective in clinical trials.
"The system makes sure that patients, nurses and doctors are in agreement. The patients sign discharge contracts saying they understand the goals; so by having a system which helps caregivers and patients to remember to pay attention to these priorities in care every time, we insure that the patients get them. In particular, by involving the patients with the discharge document, we increase the chance that the best care will be realized in the long term," Dr. Eagle said.
Although this was an observational study that was not designed to definitely prove that the GAP changes caused the declines in patient deaths, Dr. Eagle noted that a previous study did show that GAP hospitals adhered to treatment guidelines better than a group of control hospitals. He says this new study ties those improvements in care to higher rates of survival.