AHJ: Improved treatment strategies reduce MI deaths by 19%

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Four western N.Y. hospitals that used emergency treatment strategies emphasizing evidence-based therapy and better healthcare provider communication reduced heart attack deaths by 19 percent for up to one year after patient discharge, according to a study in the January issue of the American Heart Journal.

"The study shows that when you improve communication among departments about patient care, and when you take key information from published medical journals and apply them to every-day medicine, you can make a significant difference in patient outcomes and the quality of care they receive," said study lead author and practicing cardiologist John C. Corbelli, MD.

Corbelli, from the State University of New York at Buffalo School of Medicine and Biomedical Sciences in Buffalo, N.Y., and colleagues used an observational design comparing pre- (1,240) and post- (1,709) acute coronary syndrome (ACS) emergency treatment strategies (ACSETS) implementation cohorts followed over one year. Both MI (59 percent) and unstable angina (UA) (41 percent) patients were studied. They used a multivariate regression analysis to evaluate possible differences in major end points.

The researchers found that appropriate ACS medication use was significantly higher in the ACSETS group in the first 24 hours and at discharge.

In a subgroup of managed care health insurance patients (884), prescription refills for statins, ?-blockers, angiotensin-converting enzyme inhibitors, and clopidogrel were significantly greater in the ACSETS group up to and including seven months after discharge; however, at seven months, actual refill rate was poor (30 percent to 50 percent) for both groups. Length of stay was significantly reduced. However, the researchers noted that inpatient mortality was not significantly reduced. One-year adjusted mortality was reduced significantly compared to non-ACSETS in the MI group (by 19 percent), but not in the UA group.

Corbelli and colleagues concluded that ACSETS contributes to the proof of concept of critical care pathway improvement of ACS care, as revealed by increased acute and chronic evidence-based use of medication, decreased length of stay, and, in the case of MI patients, decreased adjusted one-year mortality.

The scientists noted that the one-year mortality benefit was observed for the MI group, but not the UA patients.

WellPoint subsidiary, HealthCore, performed the outcomes research for this study based on research funding from Sanofi-Aventis, Bristol-Myers Squibb and the Kaleida Health Foundation.