Hundreds of lives per year could be saved if more cardiac patients left hospital on drug therapy

Up to 400 lives per year in Ontario could be saved if more heart attack and heart failure patients received needed medications before leaving hospital. This is but one of many significant findings from the report, Quality of Cardiac Care in Ontario, released today by the Institute for Clinical Evaluative Sciences (ICES), the Heart and Stroke Foundation of Canada, and the Canadian Institutes of Health Research (CIHR).

The report presents the results of the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study, the largest and most comprehensive study of this type in the world. The EFFECT study:

• Measured the performance of Ontario hospitals in terms of the quality of cardiac care provided
• Established Canada’s first clinical ‘benchmarks’ or gold standards for cardiac care Is designed to test the effectiveness of report cards in improving the quality of care to patients.

The 85 participating Ontario hospital corporations (103 hospitals) were randomized into two groups for either early or delayed feedback on their clinical care. Today’s findings report on heart attack (i.e. acute myocardial infarction (AMI)) and heart failure (i.e. congestive heart failure (CHF)) care between 1999 and 2001 in the early results group of 44 hospital corporations (53 hospitals). Hospital-specific results for select key performance indicators are shown in Table 1 (a complete list of indicators and hospital-specific results are included in the report).

Key Findings

Heart attack patients:

• 80% of Ontario heart attack patients have at least one modifiable cardiac risk factor (smoking, hypertension, diabetes, or high lipid levels).
• The average “door to needle” time from when patients enter the emergency room to when they receive live-saving therapy with thrombolytic medications to restore blood flow through a blocked coronary artery is 37 minutes, approaching the benchmark, or target, of 30 minutes.
• Although an average of 79% of heart attack patients are put on medications such as aspirin, beta blockers, ACE inhibitors, and statins before they leave the hospital (benchmark = at least 85%), up to 250 lives per year could be saved if more patients received these medications.
• The 30-day and one-year mortality rates for heart attack patients were 12% and 20%, respectively.

Heart failure patients:

• 71% of Ontario heart failure patients have at least one modifiable cardiac risk factor.
• 82% of patients are receiving ACE inhibitors, which approaches the benchmark of at least 85%. However, less than half of patients (39%) are receiving beta-blockers on discharge when the benchmark is over 50%.
• Increasing ACE inhibitors rates and beta-blocker rates in heart failure patients could save up to 150 lives per year in Ontario.
• The 30-day and one-year mortality rates were 12% and 33%, respectively.

Implications

“Although most hospitals in Ontario are providing good cardiac care, the EFFECT study is designed to help hospitals achieve ‘excellence’ in several important aspects of cardiac patient management,” said EFFECT principal investigator, ICES senior scientist, and Canada Research Chair in Health Services Research, Dr. Jack Tu.

“We hope that hospitals will see the results of the EFFECT study as a way to assess their strengths and weakness and undertake quality improvement initiatives. By focusing on the key quality indicators and recommendations in the report, such as increasing the use of medications that will prevent a second heart attack or improve survival rates in heart failure patients, hundreds of lives each year could be saved in Ontario alone,” said Dr. Tu.

“The EFFECT findings have far reaching implications not only to Ontario, but also for patients across Canada. This research will certainly enhance the quality of care for our cardiac patients. The CIHR Institute of Circulatory and Respiratory Health (ICRH) is pleased to have sponsored this very important health service research under the stewardship of Dr. Jack Tu and his national CCORT team,” commented Dr. Arun Chockalingam, assistant director, CIHR Institute of Circulatory and Respiratory Health (ICRH).

“One of the Heart and Stroke Foundation’s key objectives is to translate valuable knowledge gained from research studies like EFFECT into practice, to protect the heart health of Canadians,” said Dr. Beth Abramson, cardiologist and Heart and Stroke Foundation spokesperson. “This important information will help us prevent heart attacks and heart failure, and more effectively treat these conditions when they do occur.”

The EFFECT study is the largest component of the CCORT project, headquartered at ICES (Institute for Clinical Evaluative Sciences). The Canadian Cardiovascular Outcomes Research Team (CCORT) was established in 2001, funded by five-year operating grants from the Canadian Institutes of Health Research (CIHR) Interdisciplinary Health Research Team (IHRT) program and the Heart and Stroke Foundation of Canada (HSF). No funding for this study was provided by the pharmaceutical industry.

ICES is an independent, non-profit corporation that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare 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 governments, hospitals, planners and practitioners to make decisions about care delivery and to develop policy.

FOR FURTHER INFORMATION, PLEASE CONTACT:

• ICES
• Julie Argles
• (416) 480-4055 ext. 3602 or cell (416) 432-8143
• [email protected]

• Heart and Stroke Foundation
• (613) 569-4361, ext. 318
• [email protected]

• CIHR Heather Rourke
• Janet Weichel
• (613) 941-4563
• [email protected]