Canadian study says better ER cardiac care could save hundreds

Main Category: Stroke
Article Date: 24 Jan 2004 - 0:00 PDT


As many as 400 lives a year in Ontario (Canada) - and untold more in other parts of Canada - could be saved if hospitals improved delivery of emergency cardiac care, says a landmark study released today.

Simple measures such as delivering damage-limiting drugs promptly after a heart attack or ensuring cardiac patients leave hospital with the right combination of medicines will save lives, the EFFECT - Enhanced Feedback for Effective Cardiac Treatment - study found.

'In today's era of limited hospital beds, crowded emergency rooms and constrained resources, the EFFECT results provide us with an inexpensive, practical and effective way of improving the health of our cardiac patients,' said Dr. Milan Gupta, head of one of the expert panels that set standards for the study.

'Simply prescribing life-saving drugs to more heart patients will clearly make a difference.'

Lead investigator Dr. Jack Tu said great advances have been made in cardiac research, but sometimes the system can be slow to embrace the new science.

'The result is a real gap between how patients should ideally be treated versus how they are actually being cared for,' said Tu, a senior scientist at the Institute for Clinical Evaluative Sciences in Toronto, which conducted the study.

The recommendations aren't high-tech and apply to hospitals across the country, the authors suggested.

'You don't have to be in a large university hospital to achieve these goals. Even the smallest rural hospital with educated physicians and nurses can achieve the same benchmarks,' said Gupta, head of cardiology at William Osler Health Centre in Brampton, Ont.

The study analysed treatment offered by 103 hospitals across the province between 1999 and 2001, looking at on average 125 heart attack cases and 125 heart failure cases from each institution. It was part of a broader study known as the Canadian cardiovascular outcomes research team.

The ongoing work is funded by the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada. The EFFECT study received no drug company funding.

Organizers released report cards on half the participating hospitals on Friday and will report on the remainder next fall as part of an effort to test whether issuing report cards on health care facilities has an impact on quality of treatment.

For the first 53 hospitals, researchers found on average, heart attack patients waited 37 minutes to receive crucial clot-busting drugs, which should be delivered within 30 minutes of arrival in a hospital. While a number of hospitals were under the 30-minute benchmark, one hospital took an average of one hour and 18 minutes to deliver the drugs.

Hospitals which delivered clot-busting drugs fastest let emergency room doctors administer the drugs rather than wait for cardiac specialists. The authors suggested all hospitals adopt such a policy.

'Time is muscle. Time is heart muscle,' said Dr. Beth Abramson, spokesperson for the Heart and Stroke Foundation, in explaining the importance of the 30-minute benchmark.

A full 79 per cent of heart attack patients left hospitals with prescriptions for the recommended medications: Aspirin, beta-blockers, ACE inhibitors and statins to combat high cholesterol. But if that figure were raised to even 85 per cent, 250 lives a year could be saved, the study suggested.

It also found doctors have been slow to embrace the new science on beta-blockers. Once thought to be verboten for heart failure patients, they are now strongly recommended. Yet only 39 per cent of heart failure patients had a prescription for a beta-blocker when they left hospital.

Bringing that figure up to a benchmark of over 50 per cent and increasing the number of heart failure patients on ACE inhibitors could save 150 lives a year, the study projected.

Doing this kind of an audit is important so hospitals have a chance to analyse how well they are doing, the experts said.

'Each physician and nurse caring for heart patients in this province strives to give their patients the best care possible,' said Gupta.

'However, without a systematic analysis of treatment patterns throughout our health-care system, we may fail to recognize gaps in our own hospitals. Without recognizing these gaps, we cannot begin to bridge them.'

The authors hope, however, the findings aren't used by patients keen to shop around for the best cardiac care unit.

'The results of today's study should not be used as a consumer guide to choosing hospitals. Patients who are suffering from chest pain should still go to their nearest room, because time is absolutely critical,' Tu said.

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