The Best And Worst States for Heart Attack

July 10, 2009— -- In the event of a heart attack or heart failure, the best course of action is to head directly to a hospital. And if that hospital is in New Jersey, so much the better.

The Garden State was among the states with the least deaths and fewest hospital readmissions following a heart attack or heart failure, according to a new study published in the journal Circulation: Cardiovascular Quality and Outcomes.

The study examined data on heart attack and heart failure patients from about 600,000 hospital admissions across the country between July 2005 and June 2008. The results showed that, while there was room for improvement in care across the board, the hospitals in some states -- like New Jersey, for example -- consistently outperformed hospitals in other states in terms of patient mortality or hospital readmission in the 30 days after they received treatment.

"While hospitals know what their financial performance is like, they are much less aware of what their clinical performance is because they lacked metrics," said Dr. Harlan Krumholz, professor of medicine in the section of cardiology at Yale University School of Medicine and the lead author of the study. "Being transparent galvanizes action at the hospital level, at the board level, and at the community level to improve performance."

Some of the states in the top fifth of the country for preventing death and hospital readmission before 30 days after treatment included:

An average of 16.6 percent of heart attack patients died within 30 days of hospital admission across the country, but this number dropped to about 10.9 percent in hospitals in the best performing states. The average number of heart failure patients who died nationally was 11.1 percent but was 6.6 percent in hospitals in the best performing states.

Arkansas

Tennessee

Missouri

Louisiana

Deaths from heart attack were about 24.9 percent and deaths from heart failure were about 19.8 percent in these states, significantly higher rates than the better-performing states.

But the study authors pointed out that hospital performance overall was poor, particularly regarding hospital readmission rates. One in four heart failure patients and one in five heart attack patients were readmitted to a hospital within 30 days of their first admission because of anything from trouble with medication, infection, poor follow up care, or another heart attack or failure.

"Being able to prevent preventable deaths is very important. Preventing early hospitalization again is also very important," said Dr. Gregg Fonarow, professor of cardiovascular medicine at UCLA and another author on the study. "The large difference highlights that more could be done."

But the authors noted that the data do not imply that every hospital in a state follows a rubric that makes them equally good at treating patients and an acute heart problem leaves little time to dally with hospital choice.

There was a large amount of variation in hospital performance within states. Florida, for example, had areas that were in the top and bottom fifth performance percentage for deaths and readmissions. Whether a hospital was rural or urban, large or small, or had a teaching component often had little impact on the data.

"For those facilities looking for answers [on how to improve], take the path of least resistance and look at what exists," said Dr. Clyde Yancy, president of the American Heart Association and medical director of the Baylor Heart and Vascular Institute in Dallas.

Guidelines for treating heart disease, like those developed by the AHA and the American Stroke Association, can be the easiest and best way to provide care that can potentially prevent deaths or hospital readmission and studies have shown that utilizing such guidelines can improve patient outcomes.

"Any kind of hospital could be good, and that points to things we're not measuring," Krumholz said.

Krumholz added those things could include hospital culture, leadership and the approach to care.

"As long as [these factors] are invisible, they are easy to ignore," Krumholz said. "We hope this will engender a lot of conversation about differences -- why they exist, underlying causes -- and how to get lagging hospitals to perform as well as the performing hospitals.