American Heart Association healthcare quality improvement program recognized by US Health and Human Services

American Heart Association
Thursday, 28 February 2002

An American Heart Association program designed to improve hospital care of heart attack patients was recently recognized by the U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services. Stephen Jencks, M.D., director of the HHS Quality Improvement Group and assistant director of HHS presented the Common Knowledge Award to the Massachusetts Peer Review Organization (MassPRO) for "developing and disseminating methods for partnership with the American Heart Association and its Get With The Guidelines program as quality improvement tools for the use of all Medicare Quality Improvement Organizations." The American Heart Association's Get With The GuidelinesSM program is an in-hospital quality improvement program to help physicians and other healthcare providers ensure that patients with coronary artery disease are treated according to standard practice guidelines. It was pilot tested in the New England area by MassPRO.

Over the past 18 months, more than 24 New England acute care hospitals implemented the Get With The Guideline Program under the leadership of Kenneth LaBresh, M.D., associate medical director, Massachusetts Peer Review Organization, Inc. and national American Heart Association volunteer.

"In the pilot, the number of individuals receiving standardized care for coronary heart disease – including drugs to lower cholesterol and blood pressure, smoking cessation counseling, and referrals to physical activity programs – improved notably with the implementation of the American Heart Association secondary prevention guidelines with Get With The GuidelinesSM," says LaBresh. "The American Heart Association hopes the U.S. Department of Health and Human Services' recognition of Get With The GuidelinesSM will encourage more hospitals, physicians and government agencies to work together to improve the quality of care for coronary heart disease patients."

Underscoring the need for the program, reports show that nationwide doctors and hospitals are not following guidelines aimed at preventing subsequent heart attacks. In a 1999 Journal of the American Medical Association article, research found only half of the eligible candidates received beta-blockers, slightly more than half received ACE inhibitors and only two-thirds were treated with clot busters.

This treatment gap may be a contributing factor in many recurrent heart attacks and other cardiovascular events. According to American Heart Association statistics, within six years after a recognized heart attack, 18 percent of men and 35 percent of women will have another heart attack, and about 22 percent of men and 46 percent of women will be disabled with heart failure.

As part of the program, hospitals focus on ongoing data measurement and rapid improvement cycles using a Web-based, real-time patient management tool. The tool provides hospitals with immediate access to the guidelines that are customized for each patient to reduce cardiovascular risk factors and ease reporting to government agencies.

The pilot tracked the treatment of 1,681 coronary heart disease patients in 22 hospitals. Eighty-one percent of individuals in the study had suffered a heart attack, while others had been treated for chest pain, congestive heart failure or coronary heart disease. Adherence rates were compared in eight risk-reduction measures, such as receiving cholesterol and blood pressure lowering drugs, smoking cessation counseling and referrals to rehabilitation or physical activity programs prior to being discharged from the hospital. The measurements were compared at baseline, four to six months later and nine to 12 months later.

Significant improvements were noted in nine to 12 months. Prior to the program only 48 percent of coronary heart disease patients were receiving smoking cessation counseling before discharge. After nine-12 months of the program, 81 percent of patients in the hospitals received advice on how to quit smoking.

The number of patients prescribed lipid-lowering drugs, such as statins, before discharge improved to more than twice the national average. And, the percent of patients referred for rehabilitation or physical activity programs more than doubled by the year-end.

Get With The Guidelines mobilizes teams in acute-care hospitals to implement the American Heart Association/American College of Cardiology secondary prevention guidelines. It advocates using quality-improvement measures -- such as care maps, discharge protocols, standing orders and measurement tools -- based on the secondary prevention guidelines. The program is being introduced in hospitals across the country through continuing medical education workshops and Web-based tools. For more the information, visit americanheart.org/getwiththeguidelines.

For more information, or to contact American Heart Association, see their website at: www.americanheart.org