Hospitals Reduce Heart Attack Deaths

Aug. 19 -- TUESDAY, Aug. 18 (HealthDay News) -- A decade-long, government-led effort has reduced the death rate for patients hospitalized for heart attacks and improved the performance of hospitals that deal with these daily emergencies, a nationwide study finds.

Between 1995 and 2006, the in-hospital death rate for Medicare patients treated for heart attacks decreased, from 14.6 percent to 10.1 percent, while the 30-day death rate in such cases dropped from 18.9 percent to 16.1 percent, according to a report in the Aug. 19 issue of the Journal of the American Medical Association.

For the study, a team of cardiologists reviewed the outcomes of more than 2.7 million cases reported by more than 500 hospitals. Over the same period, the 30-day death rate for all other conditions barely changed, from 9 percent in 1995 to 8.6 percent in 2006, the report noted.

While the decade saw major advances in the drugs and techniques used to treat heart attacks, the key element in the overall improvement was the effort by what was then the Health Care Finance Administration and now is the Center for Medicare & Medicaid Services (CMS), said study author Dr. Harlan M. Krumholz, a professor of medicine at Yale University School of Medicine.

"What CMS did was critical," Krumholz said. While other organizations, such as the American Heart Association (AHA) and the American College of Cardiology, also emphasized good heart care in hospitals, "I don't think it would have happened without a shift by Medicare in saying, 'We have to look at the entire group of hospitals'," he said.

Until the early 1990s, "the whole idea of quality improvement was to find the bad apples," he said. "The pivotal point was Medicare saying, 'We're not going to focus only on the outliers'."

There were plenty of outliers -- hospitals whose heart attack treatment results lagged behind the outcomes of most others. In the 1990s, heart attack death rates of more than 24 percent were noted at 39 hospitals. In 2006, no U.S. hospital reported such a high rate, and the death rate in the worst 1 percent was 19.5 percent.