When a patient enters a hospital complaining of chest pain or other symptoms of heart attack , hospitals must take swift and appropriate steps to minimize the risk of death. Many years of rigorous clinical trials have shown which treatments are most effective.

Based on these findings, the American College of Cardiology (ACC) and American Heart Association (AHA) have developed treatment guidelines for hospitals to follow when treating suspected heart attack patients. The guidelines include administering certain medications at appropriate times during and after the admission.

In an article published in the April 26, 2006 Journal of the American Medical Association , researchers studied whether hospitals’ use of the ACC/AHA guidelines had any effect on the outcomes of their patients. They found mortality rates were significantly lower in hospitals that best complied with the guidelines, compared to hospitals with the lowest compliance.

About the Study

The researchers analyzed the care received by 64,775 patients who had been admitted to one of 350 hospitals for suspected heart attacks. The researchers noted how well the hospitals adhered to nine ACC/AHA treatment guidelines, and grouped the hospitals into four categories by the degree to which they followed the guidelines. They then studied the relationship between adherence to the guidelines and patient outcomes.

Overall, hospitals adhered to the ACC/AHA guidelines 74% of the time. Certain treatment guidelines, such as the use of aspirin, were followed much more regularly (92% of the time, on average) than other guidelines, such as the use of clopidogrel (Plavix, another antiplatelet drug) (41% of the time, on average). Hospitals who best complied with all of the ACC/AHA guidelines had mortality rates of 4.15%, compared to mortality rates of 6.31% in hospitals with the worst compliance. This was a significant difference. In addition, every 10% improvement in guideline compliance was associated with a 10% decreased risk of death.

This study was only designed to show an association between guideline compliance and patient outcomes. It should not be construed as a cause and effect relationship.

How Does This Affect You?

This study found that patients admitted to hospitals that best followed the ACC/AHA guidelines for treating a suspected heart attack were significantly less likely to die than patients treated in hospitals with the lowest compliance. It also found that hospitals are missing one out of every four opportunities to follow established treatment guidelines.

Although you may not be able to determine how well your particular hospital adheres to the ACC/AHA guidelines, it may be worthwhile to try and find out. Some hospitals are now willing to report on guidelines adherence and similar measures of quality, and make this information available to the public. If you have heart disease, talk to your cardiologist about these guidelines. He or she may be able to reassure you that they will be followed as closely as possible in the event you need them.