Guidelines can reduce in-hospital deaths

Results from an ongoing national quality improvement initiative examining adherence to American College of Cardiology (ACC) and American Heart Association (AHA) treatment guidelines for chest pain disorders, suggest that using a class of drugs known as glycoprotein (GP) IIb-IIIa inhibitors reduced in-hospital deaths by 46%.

The data, recently released from Duke University Medical Center in Durham, NC, also show that only 31% of eligible patients were treated with a GP IIb-IIIa inhibitor within 24 hours, as recommended by the guidelines.

The initiative, referred to as CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines), is designed to determine adherence to the ACC/ AHA guidelines for patients with non-ST-segment elevation acute coronary syndromes, or high-risk chest pain disorders, and to improve clinical outcomes through the implementation of strategies to promote these guidelines.

Eric Peterson, MD, associate professor of medicine at Duke University Medical Center and principal investigator for the CRUSADE initiative, says the analysis presented looked at the outcomes of 27,786 patients treated at more than 300 hospitals in the United States.

"Our analysis of real-world practices confirms that following the ACC/AHA guidelines, which recommend early, aggressive treatment of high-risk patients, has the potential to save thousands of lives each year," Peterson says. "Our mission is to not only document guidelines nonadherence but to actually change the behavior of health care professionals and thus positively impact patients’ lives."

Patients who did not receive a GP IIb-IIIa inhibitor within 24 hours of hospitalization had an in-hospital mortality rate of 4.5%, compared to 2.5% for patients receiving the drugs early, a reduction of 46%.

In other findings, only 42% of patients received a recommended procedure known as diagnostic catheterization within 48 hours, which also was shown to improve mortality. This diagnostic procedure reduced a patient’s stay in the hospital following a chest pain disorder from 5.8 days to 4.8 days.

[For more information, contact:

  • Eric Peterson, MD, Associate Professor of Medicine, Duke University Medical Center, Trent Drive, Durham, NC 27710. Telephone: (919) 684-8111.]

Correction

The November 2002 issue of Hospital Peer Review stated incorrectly that the national average score for hospitals surveyed by the Joint Commission on Accreditation of Healthcare Organizations is 89. The average score, according to the most recent analysis by the Joint Commission, is 91.