Adherence to treatment guidelines for patients with ACS associated with decreased in-hospital deaths

April 25, 2006

Receiving care at a hospital with higher adherence to guidelines for treatment of patients with acute coronary syndromes is associated with a decreased likelihood of in-hospital death, according to a study in the April 26 issue of JAMA.

Assessing quality in health care has become increasingly important in current medical practice, according to background information in the article. Government agencies, professional societies, accreditation organizations and major insurers have published performance guidelines. The American College of Cardiology/American Heart Association (ACC/AHA) have established national clinical practice guidelines for the appropriate care of patients with non - ST-segment elevation (NSTE - a certain pattern on an electrocardiogram) myocardial infarction (MI - heart attack) acute coronary syndrome (ACS - the development of chest pain of cardiac nature).

Eric D. Peterson, M.D., M.P.H., from Duke University Medical Center, Durham, N.C., and colleagues examined how well hospitals followed ACC/AHA guideline recommendations for treating patients with NSTE ACS using data from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) National Quality Improvement Initiative between Jan.1, 2001, and Sept. 30, 2003. The study included information on 350 academic and nonacademic U.S. medical centers and 64,775 patients.

The researchers found that overall, the nine ACC/AHA recommended treatments for patients with NSTE ACS were followed in 74 percent of treatment opportunities. However, composite adherence scores varied greatly among the hospitals. Hospitals in the highest adherence group (quartile 4) had a median adherence score of 82 percent, compared to 63 percent for hospitals in the lowest group (quartile 1). These guideline adherence rates were significantly associated with in-hospital deaths; death rates ranged from 6.31 percent in the lowest adherence group to 4.15 percent in the highest adherence group. After adjusting for risk, the researchers found that every 10 percent increase in composite adherence was associated with a 10 percent decrease in its patients' likelihood of in-hospital death.

"Quality of care has been defined as 'the degree to which health service for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge,'" the authors write. "Our work supports the central hypothesis of hospital quality improvement; namely, better adherence with evidence-based care practices will result in better outcomes for patients who are treated."
(JAMA. 2006; 295: 1912 - 1920. Available pre-embargo to media at

Editor's Note: This study was supported by CRUSADE, a National Quality Improvement Initiative of the Duke Clinical Research Institute, which was funded by the Schering-Plough Corporation. Bristol-Myers Squibb/Sanofi-Aventis Pharmaceuticals Partnership and Millennium Pharmaceuticals provided additional funding support. Dr. Peterson is also the recipient of a grant from the National Institute on Aging. For the financial disclosures of the authors, please see the JAMA article.

The JAMA Network Journals

Related Hospitals Articles from Brightsurf:

'Best' hospitals should be required to deliver tobacco treatment
A UCLA-led report published today in the Journal of the American Medical Association Internal Medicine exposes what the authors call a weakness in the high-profile 'Best Hospitals Honor Roll' published annually by US News and World Report.

Veterans undergoing elective PCI at community hospitals may have increased chance of death compared to those treated at VA hospitals
Veterans who underwent elective percutaneous coronary intervention (PCI) for stable angina at a community facility were at a 33% increased hazard, or chance, of death compared to patients treated within the Veterans Affairs (VA) Healthcare System, according to an analysis of nearly 9,000 veterans published today in the Journal of the American College of Cardiology.

How should hospitals ask patients for donations?
A new study looks for the first time at patients' views of hospital fundraising, including legally allowable practices that encourage physicians to work with their hospital's fundraising professionals.

Proximity of hospitals to mass shootings in US
Nontrauma center hospitals were the nearest hospitals to most of the mass shootings (five or more people injured or killed by a gun) that happened in the US in 2019.

'Five star' hospitals often provide fewer services than other hospitals, new data suggests
If you're looking for a top-notch hospital with a wide range of services, narrowing your list to hospitals with a five-star patient experience rating might lead you astray.

Costs of care similar or lower at teaching hospitals compared to non-teaching hospitals
Total costs of care are similar or somewhat lower among teaching hospitals compared to non-teaching hospitals among Medicare beneficiaries treated for common medical and surgical conditions, according to a new study led by researchers from Harvard T.H.

How common, preventable are sepsis-associated deaths in hospitals?
This study estimates how common sepsis-related deaths are in hospitals and how preventable those deaths might be.

Veterans health administration hospitals outperform non-VHA hospitals in most markets
In a new study, researchers from The Dartmouth Institute for Health Policy and Clinical Practice and the White River Junction VA Medical Center in White River Junction, Vermont, used the most current publicly available data to compare health outcomes for VA and non-VA hospitals within 121 local healthcare markets that included both a VA medical center and a non-VA hospital.

Tele-ERs can help strengthen rural hospitals
A new study from the University of Iowa finds rural hospitals that use tele-medicine to back up their emergency room health care providers save money and find it easier to recruit new physicians.

Hospitals may take too much of the blame for unplanned readmissions
A new study out of Beth Israel Deaconess Medical Center reveals that the preventability of readmissions changes over time: readmissions within the first week after discharge are often preventable by the hospital, whereas readmissions later are often related to patients' difficultly accessing outpatient clinics.

Read More: Hospitals News and Hospitals Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to