July 10, 2009
by Radha Chitale
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 hospitals 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.”
The Best States:
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.
The Worst States:
The percentage of people who died following heart attack or heart failure within 30 days of hospital admission jumped significantly in the worst performing states:
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.