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Yale-New Haven Hospital
20 York Street
New Haven, CT
06510-3202
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August 8, 1999
News this month A study published in the May 27 issue of the New England Journal of Medicine suggests elderly patients who suffer heart attacks are more likely to survive if they are taken directly to hospitals that treat a high volume of patients with heart attacks. The lead author of the report, Dr. David Thiemann, a cardiologist at Johns Hopkins University, studied 98,898 Medicare patients who were treated for heart attacks at more than 4,000 hospitals throughout the country from February 1994 to July 1995. People taken to low-volume hospitals, defined by this study as those that treat fewer than 1.4 heart attack patients per week, were 17 percent more likely to die within 30 days than those taken to hospitals that treated at least 4.4 heart attack patients per week. “The study is the first to show
a relationship between surviving a heart attack and the experience
of the hospital where a patient is treated.”
The study calls for emergency medical systems to consider identifying certain hospitals as heart attack centers just as they now designate trauma centers. The researchers suggest 5,000 lives per year could be saved if paramedics who have positively identified patients as suffering from heart attacks transport them to these “heart centers” as long as travel time was not increased significantly. The study is the first to show a relationship between surviving a heart attack and the experience of the hospital where a patient is treated. The team also found that individuals who live in cities were more likely to survive heart attacks than those living in rural areas who were 11 percent more likely to die. The reason for this is unknown, but Dr. Thiemann suggests it may be because it takes longer to get to a hospital in most rural areas. “. . .Aggressive treatment with
aspirin, beta blockers and other drugs accounted for about one-third
of the improvement in survival rates between high and low-volume
hospitals.”
The survival benefit of younger patients in the study, those 65 to 69, was nearly double that of the whole group. Thiemann suggested people younger than 65 might benefit even more. The study confirmed previous research that found aggressive treatment
with aspirin, beta blockers and other drugs accounted for about
one-third of the improvement in survival rates between high and
low-volume hospitals. “The rest is in the intangible that you
call experience,” said Thiemann. “And experience matters.
A lot of clinical practice is still more art than science.”
And it’s not just the experience of the medical staff, according
to Thiemann, the experience of the nurses, lab technicians and everyone
on the team caring for the patient makes a difference.
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Experience counts...along with many other factors The Thiemann study infers that “practice brings us closer to perfection” when it comes to treating patients experiencing heart attacks. Indeed, large, academic, referral hospitals such as Yale-New Haven have the opportunity to care for the broadest range of patients suffering from all kinds of diseases—from the simplest to the most complex. “Yale-New Haven Hospital sees
more than 15 people with heart attacks each week.”
Yale-New Haven Hospital sees more than 15 people with heart attacks each week. This is well above the level of 4.4 per week, designated as the criterion for high-volume hospitals in the New England Journal of Medicine (NEJM) article. It may well be the people and the services that need to come into play during care of a patient with a heart attack do so more quickly and consistently than at institutions where fewer patients are treated. Ability to make good decisions quickly is important Access to innovations in diagnosis and treatment “Hundreds of ‘microdecisions’
are made in the early hours of treating a person experiencing
a heart attack....The speed and coordination of these decisions
may account for the difference in survival rates....”
Small hospitals not exempt from high quality Scope out the closest hospital delivering high quality care Assessing hospital performance Dr. Radford is a cardiologist on staff of Yale-New Haven Hospital. She is the deputy director of the Center for Outcomes Research and Evaluation.
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