AHA: Hospital certification program for cardiovascular, stroke care needed

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CHICAGO—The American Heart Association (AHA) should develop a comprehensive hospital certification program with policies and evidence-based criteria for cardiovascular disease and stroke care in the U.S., according to an AHA Presidential Advisory published Nov. 12 in Circulation, and released this week during the annual AHA Scientific Sessions.

"Our goal is to continue to reduce deaths from cardiovascular disease and stroke by 20 percent by 2020," said Ralph L. Sacco, MD, AHA president. "To do so, we have to make sure hospitals are providing the highest quality care to patients to improve their outcomes."

Annually, there are approximately 6.2 million cardiovascular and 730,000 stroke hospitalizations and 7.2 million cardiac and vascular procedures performed. Cardiovascular disease accounts for 831,000 deaths—more than 34 percent of all deaths—annually.

A comprehensive certification program would help ensure that hospitals consistently provide proven therapies and achieve better outcomes, as well as recognizing those facilities that do, said the advisory’s first author Gregg C. Fonarow, MD, professor of cardiovascular medicine at the University of California, Los Angeles.

"We want this to be objective, unbiased and really meaningful," Fonarow said. "Many studies show that the quality of care for cardiovascular disease and stroke can vary substantially depending on the hospital."

For example, the advisory stated that the hospitals differ widely in administering the preferred reperfusion therapy to unblock an artery after a STEMI; when and whether they administer appropriate medicine after stroke; whether they give patients a statin to prevent recurrent illness; and whether they refer patients for cardiac or stroke rehabilitation.

"Being able to distinguish centers that consistently provide excellent cardiovascular disease and stroke care could mean the difference between patients receiving or not receiving therapies that are highly effective and will help improve the likelihood of surviving an acute cardiovascular illness," Fonarow said.

Some programs that assess hospitals are linked to better quality of care and improved patient outcomes, according to the advisory. "But data are mixed and often differences aren't great," Fonarow said.

"It can be difficult sorting through these programs, and there isn't really, from a trusted source, a single certification program that consumers, insurers, clinicians and the public can use to understand which hospitals are providing exceptional overall cardiovascular and stroke care.”

A comprehensive certification program would build on the AHA/American Stroke Association's (ASA) Get With the Guidelines performance improvement and recognition programs. Since the association launched the programs a decade ago, more than 1,500 hospitals have implemented them in areas including stroke, heart failure and resuscitation.

The AHA also has partnered with the Joint Commission to provide advanced hospital certification in heart failure care and certification of hospitals as primary stroke centers.

"We know that for stroke care, stroke certification has really made a difference," said Sacco, who is chairman of the neurology department at the University of Miami Miller School of Medicine.

Hospital stakeholders want a credible program with meaningful ratings that recognize high standards and operational excellence, according to a small AHA/ASA survey.