Recent High Impact Publications from the American Heart Association's Get With the Guidelines Program
Disclosure:Deepak L. Bhatt, through his institution, receives significant grant monies from AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Heartscape, Sanofi-Aventis, and The Medicines Company.
Pub Date: Tuesday, February 2, 2010
Author: Deepak L. Bhatt, MD, MPH, FAHA
The American Heart Association's Get With the Guidelines program is an excellent way to improve the care that patients receive. Importantly, the Get With the Guidelines program also supports important scientific investigation. The outcomes science that is supported by the Get With the Guidelines program has lead to several recent publications that truly impact the daily practice of medicine. In addition, these publications will likely have significant policy implications.
The paper by Kumbhani et al. examined the association between volume of procedures to treat heart attack patients and the associated outcomes. This analysis found no relationship between higher hospital volumes of angioplasty procedures for heart attack with mortality. This is in contradistinction to previous work in the area and may reflect changes that have occurred since the time of those initial reports, which did show a relationship between lower hospital procedural volume and higher rates of death. Part of the reason that there was no apparent relationship between inhospital mortality and procedural volume may have to do with the fact that all the hospitals in this analysis were, of course, participating in the American Heart Association's Get With the Guidelines Quality Improvement Initiative, and that, within this context, procedural volume doesn't seem to matter as much as it used to matter. It is conceivable that the types of hospitals participating in this quality improvement initiative and their associated efforts to, in fact, monitor and improve quality have done just that. Therefore, it is important not to generalize these results to every hospital because it is certainly conceivable that a small, low-volume hospital not participating in a quality improvement initiative could have less than optimal outcomes. It is also possible that with longer term follow-up, some relationship between mortality and procedural volume would have emerged, even among the group of patients that were studied in this analysis. Nevertheless, the study provides further evidence that merely measuring and reporting volume of a procedure is not a surrogate measure of quality or of outcome.
The paper by Albert et al. examined patients from the American Heart Association's Get With the Guidelines Heart Failure program and documented that less than one-third of eligible patients hospitalized with heart failure received aldosterone antagonists. Aldosterone antagonists have data supporting their use in the heart failure population, and it is an important and sobering message that a relatively small percentage of these patients are receiving this form of therapy. This creates an opportunity in the future to improve the care of heart failure patients by making sure that those with indications for aldosterone antagonist therapy, and without contraindications, actually receive this medication.
These two publications by Kumbhani et al. and Albert et al. were published in the Journal of the American Medical Association. This is really quite an accomplishment for the American Heart Association's Get With the Guidelines program to have two papers published in this prestigious journal. I think this attests to the quality of the data being collected and analyzed for the American Heart Association's Get With the Guidelines initiative. Everyone who is part of this quality improvement effort should feel proud of their contributions in advancing medical science.
There were several other nice publications as well. The paper by Peterson et al. was published in Circulation Cardiovascular Quality and Outcomes. This paper describes a risk score from Get With the Guidelines Heart Failure program that uses commonly available clinical variables to predict inhospital mortality. This risk score is something developed out of the Get with the Guidelines heart failure database and may find broad clinical usage in the years to come. In the paper by Heidenreich et al. published in the American Heart Journal, the authors examined those hospitals receiving achievement awards from the Get with the Guidelines program versus those which did not. Hospitals receiving such awards had lower risk-adjusted mortality for acute myocardial infarction and heart failure compared with other hospitals. This finding provides evidence that recognition within the Get with the Guidelines program certainly does seem to identify hospitals that are providing better care. These findings provide support that the Get with the Guidelines program is leading to improvements in the processes of care that ultimately translate into better patient outcomes, including lower mortality. Again, these papers highlight findings that should serve as a source of pride for everyone involved with the American Heart Association's Get with the Guidelines program.
- Kumbhani DJ, Cannon CP, Fonarow GC, et al. Association of hospital primary angioplasty volume in ST-segment elevation myocardial infarction with quality and outcomes. JAMA 2009;302:2207-2213.
- Albert NM, Yancy CW, Liang L, et al. Use of aldosterone antagonists in heart failure. JAMA 2009;302:1658-1665.
- Peterson PN, Rumsfeld JS, Liang L, et al. A validated risk score for in-hospital mortality in patients with heart failure from the American Heart Association Get With the Guidelines Program. Circ Cardiovasc Qual Outcomes 2010;3: published online ahead of print.
- Heidenreich PA, Lewis WR, LaBresh KA, et al. Hospital performance recognition with the Get With The Guidelines Program and mortality for acute myocardial infarction and heart failure. Am Heart J 2009;158:546-553.
-- The opinions expressed in this commentary are not necessarily those of the editors or of the American Heart Association --