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Where heart attack patients receive care matters

November 26, 2009 Toronto

Researchers have found three key hospital management markers are associated with improved survival rates for heart attack patients across Ontario. New research from the Institute for Clinical Evaluative Sciences (ICES) shows appropriate initial emergency department (ED) assessment, high rates of appropriate cardiac drug prescribing at patient discharge and high rates of cardiac revascularization can reduce the number of readmissions.

“We studied the 77 largest hospitals in Ontario since they were assumed to provide the best care for heart attack patients. We found vast differences in quality and outcomes among these hospitals; in fact, a patient’s chances of dying or having another heart attack were more than doubled, depending where they were treated,” says principal investigator and ICES scientist, Dr. Therese Stukel.

The study of 98,115 heart attack patients in 77 of Ontario’s largest hospitals between 2000 and 2006 found:

  • Thirty-day mortality ranged from 7 to 17 per cent, and six-month cardiac readmission ranged from 18 to 36 per cent.
  • Three hospital cardiac management factors predicted better patient outcomes: appropriate initial emergency department (ED) assessment, high rates of cardiac revascularization to urgent patients and high levels of appropriate cardiac drug prescribing at patient discharge.
  • Patients admitted to hospitals with the highest rates of the three cardiac management factors combined had 16 per cent lower rates of 30-day mortality and 35 per cent lower rates of six-month cardiac readmissions.
  • These findings could stimulate quality improvement efforts across all hospitals to improve care, particularly, taking advantage of Ontario's regionalized Cardiac Care Network to provide rapid revascularization.

“Where patients receive care for a heart attack matters. Hospital quality improvement efforts seem to be paying off but we have a way to go in terms of increasing quality across all hospitals. Improvements such as more appropriate ED triage, hospital standing orders to provide necessary medications to all patients, and better use of Ontario's Cardiac Care Network do not require additional resources and are within the reach of all hospitals,” says Stukel.

The study “Association between hospital cardiac management and outcomes for acute myocardial infarction patients” is in the current online issue of PubMed.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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