Heart Attack Care Performance Detail  

 

What this information tells us

Results

What one should know about the data

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What this information tells us

What’s important to know about aspirin and heart attack treatment 

• The American Heart Association recommends aspirin use for patients who have had a heart attack (unless the patient has other conditions that prevent him or her from safely taking aspirin.) ^{2, 35, 36}
• For certain types of heart attack, aspirin is beneficial because it reduces the tendency of blood to clot in blood vessels of the heart and improves the chance a patient will survive. ^{2, 35, 36}
• National guidelines strongly recommend the early administration of aspirin for some heart attack patients. Some patients are allergic to aspirin, or are taking medicines that cannot be taken with aspirin, among other reasons. ^{2, 3, 35,36}  
• Do not start aspirin therapy without first consulting your doctor; the risks and benefits vary for each person. ^{1, 35, 36}

Results 

• In 2006, Joint Commission-accredited hospitals achieved average performance of 96.6 percent in providing heart attack patients with aspirin within 24 hours of arriving at the hospital – an improvement of 1.1* percentage points from 2005,  of 1.9* percentage points from 2004, of 2.3 percentage points from 2003, and of 3.6 percentage points from 2002.

• Performance rates among states ranged from 94.9 to 99.1 percent.

What one should know about the data

• Only four hospitals in Wyoming underwent on-site surveys during 2006.
• Some heart attack patients received this treatment but were excluded from these data for one or more of the following reasons:
• The patient did not receive aspirin due to an allergy to aspirin or other medical reasons.
• The patient was younger than 18 years of age.
• The patient was transferred to another acute care or federal hospital on the day of arrival.
• The patient was transferred from another acute care hospital, including another emergency department.
• The patient was discharged on the same day of arrival at the hospital.
• The patient left against medical advice on the day of arrival.
• The patient received comfort care only.
• The patient died on the day of arrival at the hospital.  

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What this information tells us

What’s important to know about taking aspirin after having a heart attack 

• The American Heart Association recommends aspirin use for patients who have had a heart attack (unless the patient has other conditions that prevent him or her from safely taking aspirin.) ^{2, 35, 36}
• For certain types of heart attack, aspirin is beneficial because it reduces the tendency of blood to clot in blood vessels of the heart and improves the chance a patient will survive. ^{2, 35, 36}
• National guidelines strongly recommend that some heart attack patients continue to take aspirin to prevent another heart attack. Some patients are allergic to aspirin, or are taking medicines that cannot be taken with aspirin, among other reasons. ^{2, 3, 35, 36}
• Do not start aspirin therapy without first consulting your doctor; the risks and benefits vary for each person. ^{1, 35, 36} 

Results

• In 2006, Joint Commission-accredited hospitals achieved national average performance of 96.6 percent in prescribing aspirin to heart attack patients at hospital discharge – an improvement of 1.0 percentage point from 2005, of 2.1 percentage points from 2004, of 2.9 percentage points from 2003, and of 4.6 percentage points from 2002.
• Performance rates among states ranged from 94.6 to 99.1 percent.  

What one should know about the data

• During 2006, 58 hospitals in Louisiana and 90 hospitals in Florida underwent on-site surveys.
• Some heart attack patients received this treatment but were excluded from these data for one or more of the following reasons:
  • The patient did not receive aspirin due to an allergy to aspirin or other medical reasons.
  • The patient was younger than 18 years of age.
  • The patient was transferred to another acute care or federal hospital.
  • The patient was discharged to hospice. 
  • The patient left against medical advice.
  • The patient received comfort care only.
  • The patient died.  

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What this information tells us

What’s important to know about ACE inhibitors, ARBs, and heart attack

• Studies show that heart attack patients who are treated with an ACE inhibitor and ARB medicine live longer than patients who do not take these medications. ^{4, 35, 36}
• National guidelines strongly recommend ACE inhibitor and ARB medicines for heart attack patients. ^{5, 35, 36}           

Results  

• In 2006, Joint Commission-accredited hospitals achieved national average performance of 86.7 percent in prescribing an ACE inhibitor or ARB medication to heart attack patients discharged from the hospital – an improvement of 3.1 percentage points from 2005, of 6.8 percentage points from 2004, of 8.4 percentage points from 2003, and of 10.9 percentage points from 2002.

• Performance rates among states ranged from 78.0 to 94.9 percent.

What one should know about the data

• Some heart attack patients received this treatment but were excluded from these data for one or more of the following reasons:
  • The patient did not receive an ACE inhibitor or ARB medication due to an allergy to these medications or other medical reasons.
  • The patient was younger than 18 years of age.
  • The patient was transferred to another acute care or federal hospital.
  • The patient was discharged to hospice.
  • The patient left against medical advice.
  • The patient received comfort care only.
  • The patient died.  

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What this information tells us

What’s important to know about smoking and heart attack

• More than 25 percent of adult American men and 20 percent of adult American women are smokers. ^{6, 35, 36}
• Studies show that smokers are more likely to quit smoking if a doctor advises them to do so. ^{7, 35, 36}
• One year after quitting smoking, a person’s risk of heart disease decreases by 50 percent. ^{6, 35, 36}  
• National guidelines strongly recommend smoking cessation counseling for heart attack patients who smoke. ^8,35,36         

Results 

• In 2006, Joint Commission-accredited hospitals achieved national average performance of 96.6 percent in advising heart attack patients to quit smoking – an improvement of 4.5 percentage points from 2005, of 12.3* percentage points from 2004, of 20.4 percentage points from 2003, and of 30.0 percentage points from 2002.
• There is significant variability across the nation, with performance rates among states ranging from 87.8 to 99.1 percent.  
  

What one should know about the data

• Some heart attack patients received smoking cessation advice but were excluded from these data for one or more of the following reasons:
  • The patient was younger than 18 years of age.
  • The patient was transferred to another acute care or federal hospital.
  • The patient was discharged to hospice.
  • The patient left against medical advice.
  • The patient received comfort care only
  • The patient died.

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What this information tells us

What’s important to know about beta blockers after heart attack 

• Beta blocker medicine has been shown to reduce further heart damage. ^{9, 35, 36}

• Beta blocker medicine protects the heart by slowing the heart and helping the heart use less energy to pump blood. ^{1, 35, 36}

• National guidelines strongly recommend that heart attack patients continue taking beta blocker medicine to prevent another heart attack. ^{5, 35, 36} 

Results 

• In 2006, Joint Commission-accredited hospitals achieved national average performance of 96.2 percent in prescribing beta blocker medication to heart attack patients at hospital discharge – an improvement of 1.4 percentage points from 2005, of 3.7 percentage points from 2004, of 5.9 percentage points from 2003, and of 8.9 percentage points from 2002.
• Performance rates among states ranged from 93.7 to 99.1 percent.

What one should know about the data

• Some heart attack patients received this treatment but were excluded from these data for one or more of the following reasons:
  • The patients did not receive a beta blocker medicine due to an allergy to the medication or other medical reasons.
  • The patient was younger than 18 years of age.
  • The patient was transferred to another acute care or federal hospital.
  • The patient was discharged to hospice.
  • The patient left against medical advice.
  • The patient received comfort care only.
  • The patient died.   

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What this information tells us

What’s important to know about beta blockers and heart attack

• Beta blocker medicine has been shown to reduce further heart damage. ^{9, 35, 36}
• National guidelines strongly recommend that heart attack patients receive beta blocker medicine soon after having a heart attack. ^{5, 35, 36}

Results

• In 2006, Joint Commission-accredited hospitals achieved national average performance of 93.6 percent in providing patients with beta blocker medication within 24 hours after arriving at the hospital – an improvement of 1.4 percentage points from 2005, of 3.6 percentage points from 2004, of 5.4 percentage points from 2003, and of 8.6 percentage points from 2002.
• Performance rates among states ranged from 88.7 to 98.0 percent.

What one should know about the data

• Some heart attack patients received this treatment but were excluded from these data for one or more of the following reasons:
  • The patient did not receive a beta blocker medicine due to an allergy to the medication or other medical reasons.
  • The patient was younger than 18 years of age.
  • The patient was transferred to another acute care or federal hospital on the day of arrival at the hospital.
  • The patient was transferred from another acute care hospital, including another emergency department.
  • The patient was discharged on the same day of arrival at the hospital.
  • The patient left against medical advice on the day of arrival.
  • The patient received comfort care only.
  • The patient died on the day of arrival at the hospital. 

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Heart Attack Care
Fibrinolytic therapy within 30 minutes of hospital arrival: 2006 National Rates 

What this information tells us

These data report the percentage of heart attack patients who received a medicine called fibrinolytic therapy within 30 minutes of arriving at the hospital. While fibrinolytic therapy is not appropriate for all heart attack patients, national guidelines establish a 30-minute optimum timeframe for getting this medicine to patients who might benefit from it.  

What’s important to know about fibrinolytic therapy and heart attack

• Fibrinolytic therapy is only used in certain types of heart attacks. ^{10, 35, 36}
• Fibrinolytic therapy breaks up blood clots, which increases blood flow to the heart. If blood flow is returned to the heart muscle quickly during a heart attack, the risk of death is decreased. ^{1, 35, 36}
• ^{It is important that this medicine be given quickly after a heart attack is diagnosed.} 3, 36, 37
• Studies show that each hour of delay in providing fibrinolytic therapy costs nearly two lives per 1,000 heart attack patients. ^{10, 35, 36}
• National guidelines recommend that fibrinolytic therapy be given within 30 minutes of arrival at the hospital to patients who are having the type of heart attack that fibrinolytic therapy helps. ^{3, 35, 36}

Results

• In 2006, Joint Commission-accredited hospitals achieved a national average performance of 42.5 percent in providing fibrinolytic therapy within 30 minutes of the patient’s arrival at the hospital – an improvement of 3.9 percentage points from 2005, when this measure was first recorded. In 2006, the name of this measure changed from “thrombolytic” to “fibrinolytic” therapy.

• While this measure had poor performance nationwide, only 10 individual hospitals were able to publicly report data on this measure because a minimum of 30 patients was required to report data.

What one should know about the data

• Fibrinolytic therapy is only done at certain hospitals since it is a specialized service requiring trained personnel.
• Some heart attack patients received this treatment but were excluded from these data for one or more of the following reasons:
  • The patient was younger than 18 years of age.
  • The patient was transferred from another acute care hospital, including another emergency department.
  • The patient received comfort care only.

 

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Key to abbreviations: ACEI: Angiotensin converting enzyme inhibitor, ARB: angiotensin receptor blocker. See Glossary for definitions.

 

What this information tells us

These graphs show the national performance rates of Joint Commission-accredited hospitals over the course of four consecutive years (2002-2006) for six of the seven heart attack measures evaluated in this report.  

What's Important to know about heart attack

• Every year, more than 1 million Americans have heart attacks. About half die from the heart attack, and about half of those who die do so within one hour of the start of symptoms and before reaching the hospital. ^{1, 35, 36}
• Most people do not seek medical care for two hours or more after symptoms begin. Many people wait 12 hours or longer to seek treatment. Prompt treatment of a heart attack can help prevent or limit lasting damage to the heart and can prevent sudden death. ^{1, 35, 36}  

Results

• Joint Commission-accredited hospitals reported steady improvement over the course of the study in six of the seven heart attack measures. The most significant improvement was in providing smoking cessation advice to heart attack patients.

• The best rates of performance were for:

  • Providing aspirin at discharge improved from 92.0 percent in 2002, to 93.7 percent in 2003, to 94.5 percent in 2004, to 95.6 percent in 2005, to 96.6 percent in 2006.

  • Providing aspirin at arrival improved from 93.0 percent in 2002, to 94.3 percent in 2003, to 94.7 percent in 2004, to 95.5* percent in 2005, to 96.6 percent in 2006.

  • Providing beta blocker at discharge improved from 87.3 percent in 2002, to 90.3 percent in 2003, to 92.5 percent in 2004, to 94.8 percent in 2005, to 96.2 percent in 2006.

• In 2002, only 66.6 percent of accredited hospitals were providing smoking cessation advice to heart attack patients. In 2006, there was significant improvement, with 96.6 percent of hospitals providing smoking cessation advice to heart attack patients.

• The greatest need for improvement is for providing fibrinolytic therapy within 30 minutes of arrival at the hospital. With 42.5 percent national performance, this measure had the lowest national performance of all the measures in this report. While this measure had the poorest performance nationwide, only 10 individual hospitals were able to publicly report data on this measure because a minimum of 30 patients was required to report data.  

What one should know about the data

• These data measure specific “processes” of care for heart attack. In this instance, the study counts the number patients receiving the recommended care for heart attack.
• While improvement sometimes is less than 1 percentage point, these are statistically significant improvements because of the larger number of hospitals that reported these data during the time period covered in this graph.

 

* This number varies from that in the previous report due to later additional data submissions and/or corrections to previously submitted data.