Author + information
- Received January 21, 2011
- Revision received April 14, 2011
- Accepted May 10, 2011
- Published online August 2, 2011.
- Tracy Y. Wang, MD, MHS, MSc⁎,⁎ (, )
- David Dai, PhD, MS⁎,
- Adrian F. Hernandez, MD, MHS⁎,
- Deepak L. Bhatt, MD, MPH†,
- Paul A. Heidenreich, MD‡,
- Gregg C. Fonarow, MD§ and
- Eric D. Peterson, MD, MPH⁎
- ↵⁎Reprints requests and correspondence:
Dr. Tracy Y. Wang, Duke Clinical Research Institute, 2400 Pratt Street, Durham, North Carolina 27705
Objectives This study examined the degree to which hospital performance for acute myocardial infarction (AMI) and heart failure (HF) care processes are correlated.
Background Although AMI and HF care processes may be amenable to similar quality improvement interventions, whether these are indeed correlated and whether hospitals with consistently superior performance for both care metrics have the best outcomes remains unknown.
Methods We compared hospital performance of the Centers for Medicare & Medicaid Services AMI and HF core measures in 283 hospitals submitting 10 or more patients to the Get With The Guidelines AMI and HF programs between January 2005 and April 2009.
Results Median hospital adherence to AMI and HF composite measures were 93% (interquartile range: 87% to 97%) and 92% (interquartile range: 85% to 96%), respectively, with only a modest correlation between hospital performance on these 2 composite metrics (r = 0.50; 95% confidence interval: 0.41 to 0.58). Hospitals with superior performance to both AMI and HF processes had significantly longer duration of Get With The Guidelines participation and lower adjusted in-hospital mortality (odds ratio: 0.79; 95% confidence interval: 0.63 to 0.99) for AMI and HF patients, whereas hospitals with superior adherence to either alone had similar mortality rates as hospitals with superior adherence to neither measure.
Conclusions Hospitals that had consistent, superior performance for both AMI and HF care had significantly lower risk-adjusted mortality than those with superior performance either alone or for neither measure. Whether a single scoring system to assess global, rather than condition-specific, quality of cardiovascular care would facilitate care quality improvement more consistently and would optimize patient outcomes merits further investigation.
Dr. Wang has received research grants from Bristol-Myers Squibb/Sanofi-Aventis Partnership, Merck/Schering-Plough, The Medicines Company, Heartscape, Canyon Pharmaceuticals, and Eli Lilly/Daiichi Sankyo Alliance; and is a consultant to Medco. Dr. Hernandez has received research grants from Johnson & Johnson, Merck & Co., and Proventys; and is a consultant to AstraZeneca, Corthera, Inc., and Medtronic, Inc. Dr. Bhatt has received research grants from Bristol-Myers Squibb, Eisai, Sanofi-Aventis, The Medicines Company, and AstraZeneca. Dr. Heidenreich has received research grants from Medtronic. Dr. Heidenreich has received a grant from Medtronic. Dr. Fonarow has received research grants from the National Heart, Lung and Blood Institutes and AHRQ; is a consultant to Novartis and Pfizer; and has received honorarium from Medtronic. Dr. Peterson has received research grants from Bristol-Myers Squibb/Sanofi-Aventis Partnership, Merck/Schering-Plough, Eli Lilly/Daiichi Sankyo Alliance, and Johnson & Johnson. All other authors have reported that they have no relationships to disclose. The Get With The Guidelines program is provided by the American Heart Association. The Get With The Guidelines-Heart Failure program is currently supported in part by Medtronic, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. The Get With The Guidelines-Heart Failure program has been funded in the past through support from GlaxoSmithKline and the Merck Schering-Plough Partnership. These industry sponsors did not participate in the design, analysis, preparation, review, or approval of this manuscript. The Get With The Guidelines-Coronary Artery Disease program was provided by the American Heart Association and was supported in part through the American Heart Association Pharmaceutical Roundtable and an unrestricted educational grant from Merck.
- Received January 21, 2011.
- Revision received April 14, 2011.
- Accepted May 10, 2011.
- American College of Cardiology Foundation