University of Miami Miller School cardiologists have led research showing that hospitals using the American Heart Association’s Get With The Guidelines®–Coronary Artery Disease (CAD) program have improved their evidence-based treatment for heart attack patients and eliminated racial and ethnic disparities of care. The report is published in the May 17 issue of Circulation: Journal of the American Heart Association.
The findings, led by Mauricio G. Cohen, M.D., associate professor of medicine in the Cardiovascular Division, are the first to show that participating in a quality improvement program such as Get With The Guidelines–CAD can eliminate disparity gaps in quality cardiovascular care. Use of such a program can also increase the overall use of evidence-based care for heart attack patients.
The American Heart Association’s Get With The Guidelines® quality improvement program was designed to help hospitals treat patients with evidenced-based medicine that is known to improve health outcomes. Cohen, who is also director of the Cardiac Catheterization Laboratory at the University of Miami Hospital, collaborated with seven other cardiologists, including Mauro Moscucci, M.D., M.B.A., professor and clinical vice chair of medicine and chief of the Cardiovascular Division at the Miller School.
For this study, researchers looked at the records of more than 142,000 patients (Caucasian, African-American, and Hispanic) who were treated for heart attacks at 443 hospitals participating in Get With The Guidelines–CAD from January 2002 to June 2007. They examined trends over time in hospitals’ use of performance measures that evaluate treatments and interventions that improve patient outcomes.
Throughout the five years, the use of individual performance measures in the overall population was high and steadily improved for all three patient groups. Performance measures for treating heart attack patients include interventions such as administrating aspirin, beta-blockers and other appropriate medications, cholesterol-lowering therapies and smoking cessation counseling.
The combination of these measures, known as defect-free care, is the proportion of patients receiving all the appropriate treatments for which they were eligible. When the study began, less than 70 percent of each of the groups was receiving defect-free care, with African-Americans at just 58 percent. By the end of the study, at least 93 percent of each group was receiving defect-free care.
“Our most notable finding was that the initial racial-ethnic differences in care slowly decreased, as sites continued to participate in the quality improvement initiative,” Cohen said. “Additionally, care improved across all hospitals over the study period – even at those that disproportionately cared for African Americans and Hispanics.”
Previous research has suggested that one of the reasons for disparate care is that minority patients are more likely to be treated at hospitals that provide inferior care. Cohen says these findings demonstrate that this is not the case in hospitals participating in this quality improvement program.
Moscucci observes that prior regional collaborative programs have shown the ability of improving quality of cardiovascular care at a regional or state wide level. He agrees that the value of this study is in showing how a program such as this can be expanded to a national level, with greater impact. “It supports the hypothesis that spontaneous participation in national collaborative quality improvement efforts can result in improved care, without the need of a punitive approach, and it is one of the very first in showing how this approach can help in narrowing the gap across racial groups.”
Ralph Sacco, M.D., professor and chair of neurology at the Miller School and president-elect of the American Heart Association, describes the guidelines as a “powerful tool for evaluating and improving performance of care for cardiac disease, heart failure and stroke.” He says there have been marked improvements in hospitals taking part in the program and “Dr. Cohen and his group have been able to show that these improvements also help greatly improve care for those racial and ethnic groups at greatest risk for cardiovascular disease and stroke.”
Ideally, all patients would be receiving 100 percent defect-free care, says Cohen. He points out that this study reinforces the importance of quality improvement initiatives, but adds that “it’s equally important that patients be compliant to the treatments initiated during their hospital stay and modify their lifestyle to become more physically active, maintain a healthy diet and avoid cigarette smoking.”