Heart attack deaths fall after Medicare guidelines

Tue Aug 18 20:58:34 UTC 2009

WASHINGTON (Reuters) - Clearer U.S. guidelines on how to treat elderly heart attack patients appear to have saved lives, with a marked reduction in heart attack deaths over 10 years, researchers reported Tuesday.

They found a 3 percent drop in the number of patients who died within a month of having a heart attack between 1995 and 2006, after Medicare started applying clearer standards on treatments.

"Among Medicare beneficiaries, for every 33 patients admitted in 2006 compared with 1995, there was 1 additional patient alive at 30 days," Dr. Harlan Krumholz of the Yale University School of Medicine in Connecticut and colleagues wrote in the Journal of the American Medical Association.

They also found a lot less variation in death rates from one hospital to another -- a finding that might support healthcare reform efforts that include more standardized guidelines on patient care.

Krumholz and colleagues studied the records of 2.7 million patients discharged from 4,000 hospitals after having heart attacks between 1995 and 2006.

The patients were over the age of 65, when Medicare, the federal health insurance plan for the elderly, kicks in.

In the past, various hospitals have had highly differing success rates in treating heart attack. Doctors have many choices -- angioplasty to clear out clogged arteries, heart bypasses or drugs to lower cholesterol, reduce clotting and regulate heart beat.

In 1990, the American College of Cardiology and the American Heart Association published joint guidelines on which care was appropriate and when. Medicare followed in 1992.

This appeared to help, said Krumholz. "The 30-day mortality rate decreased from 18.9 percent in 1995 to 16.1 percent in 2006, and in-hospital mortality decreased from 14.6 percent to 10.1 percent," his team wrote.

"Although the cause of the reduction cannot be determined with certainty, this finding may reflect the success of the many individuals and organizations dedicated to improving care during this period."

And the worst hospitals did a lot better. In 1995, 24 percent or more of heart attack patients died within a month after being treated at 39 hospitals.

By 2006 the worst death rate, in 1 percent of hospitals, was 19.5 percent.

"The change resulted from a shift in the entire spectrum of performance among hospitals and a decrease in the variation in performance," Krumholz and colleagues wrote.

Congress is working on healthcare reform, the signature policy of President Barack Obama. Obama has said better quality of care can bring down costs but none of the proposals being considered yet addresses this issue.

A report last week from Thomson Reuters found stressing quality care helped heath systems, with the best-performing 20 percent seeing 25 percent fewer deaths than the 20 percent worst performers.