MONDAY, April 30 (HealthDay News) -- The odds you'll survive a
heart attack vary widely depending on where you're treated in the
United States, according to a new study by Yale University
Hospitals that follow five simple strategies -- including good
teamwork and having cardiologists on hand 24/7 -- have twice the
30-day survival rates of other medical centers, the study
But fewer than 10 percent of the 500-plus U.S. hospitals studied
follow even four of the five practices, the study authors said.
"If we could implement all of the strategies across the nation, we would save thousands of lives annually," said lead researcher Elizabeth Bradley, a professor of public health at the Yale School of Public Health in New Haven, Conn. "Relatively simple strategies and a culture that focuses not on hiding problems but on finding and solving problems is the best medicine we can give ourselves."
The strategies include monthly meetings with doctors and
paramedics to review heart attack cases; having cardiologists
always available; encouraging creative problem solving;
specializing nursing duties and better teamwork between doctors and
Encouraging creative problem-solving and better doctor-nurse
teamwork appeared to have the most effect, reducing deaths by 0.84
percent and 0.88 percent respectively. Monthly reviews with doctors
and emergency transport personnel lowered deaths by 0.70 percent;
keeping heart specialists on site brought deaths down 0.54 percent
and using only specialized nurses cut deaths by 0.44 percent.
"These strategies are a mix of concrete processes and the overall culture of the hospital," Bradley said. They are also "relatively inexpensive and do not require a lot of capital investment, but rather reflect how people work with each other."
For the study, published in the May 1 issue of the
Annals of Internal Medicine, Bradley's team looked at deaths after heart attacks in 537 hospitals from January 2008 to December 2009.
Fewer than one-quarter of the hospitals held monthly meetings
with the paramedics who transported heart attack patients, and only
14 percent had a cardiologist on duty at all times, the study
found. Having a pharmacist accompany doctors on medical rounds also
improved odds of survival, but just 35 percent of the hospitals
studied did so.
Still, while these management strategies were associated with
improved survival rates, the authors cautioned that the study
cannot establish cause and effect.
Speaking on behalf of the American Heart Association, Dr. Gregg
Fonarow, a professor of cardiology at the University of California,
Los Angeles, said that "owing to advances in care and performance
improvement programs, there have been significant improvements in
survival in patients presenting with an acute heart attack."
Nevertheless, there appear to be substantial opportunities to
further improve outcomes of these patients, he said.
In this study, certain strategies were found to have
statistically significant but small associations with differences
in 30-day mortality.
"Additional efforts are needed to implement evidence-based, guideline-recommended therapies in all eligible acute heart attack patients and further promote effective strategies, performance improvement programs and systems of care," Fonarow said.
The American Heart Association and the American College of
Cardiology together with the American Heart Association offer
highly effective guidelines for hospitals that want to improve care
of heart attack patients, he said.
For more information on heart attacks, visit the
U.S. Heart, Lung, and Blood Institute.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.