AHRQ: Heart attack deaths drop 37% between 2000 and 2007
“Americans too often do not receive care that they need, or they receive care that causes harm,” the report stated. “Care can also be delivered too late or without full consideration of a patient’s preferences and values. Many times, our system of healthcare distributes services inefficiently and unevenly across populations.”
The report by AHRQ, in collaboration with the Department of Health and Human Services (HHS), looks at four sectors of quality: effectiveness, patient safety, timeliness and patient-centeredness.
The report found that the median level of receipt of needed services was 58 percent. “We can and should do better,” the authors wrote.
“Moreover, despite efforts to transform the U.S. healthcare system to focus on effective preventive and chronic illness care, it continues to perform better when delivering diagnostic and therapeutic care in response to acute medical problems.”
Overall, the report showed that the upper Midwest and New England offer the highest quality of care to patients while the Southwest and South Central states “may benefit from more urgent attention,” wrote AHRQ.
The latest data showed that between 2000 and 2007, the rate of in-hospital deaths for heart attack patients dropped by 37 percent—106 per 1,000 patients versus 67 per 1,000 patients.
Additionally, AHRQ reported that uninsured or self-pay patients were more likely than those on Medicaid, Medicare or private insurance to die in the hospital after heart attack.
These rates dipped by 37 percent for Medicare patients, 27 percent for Medicaid patients and 32 percent for the uninsured from 2000-2007.
During the period, hospitals located in the West were ranked number one for the highest rate of heart attack deaths in the country—71 deaths per 1,000 heart attack admissions in 2007.
And, between 2000 and 2007, hospitals located in the Midwest went from number one in hospital deaths for heart attack to having the lowest—112 to 63 deaths per 1,000 heart attack admissions.
Additionally, the report found that the death rate for heart attack dropped the most in hospitals with 500 or more beds and was 1.5 times lower than hospitals with 100 beds of fewer—60 versus 87 deaths per 1,000 admissions.
AHRQ also reported that in 2006 there were 16.8 million cases of coronary heart disease (CHD) cases, 5.7 million cases of heart failure and 7.9 million cases of heart attack.
Overall, the total costs associated with cardiovascular disease in 2009 were $474.8 billion while the costs related to HF alone reached $37.2 billion
The report found that nine states: Arkansas, Hawaii, Iowa, Kansas, Nebraska, Nevada, Oklahoma, Utah, and Vermont exhibited the highest rates of death for heart attack in 2006. For the aforementioned states the mean rate of inpatient mortality ranged from 82.9 to 96.2 deaths per 1,000 admissions.
On the upside, 2007 data showed that 93.1 percent of the recommended hospital care and treatment was received by HF patients and the rate of hospital care for HF improved for each age group between 2005 and 2007.
Also studied was the timeliness of care for emergency cardiac patients, specifically measuring the timeliness of PCI within 90 minutes and administering fibrinolytic medication within 30 minutes.
“The capacity to treat hospital patients in a timely fashion is especially important for emergency situations, such as heart attacks,” the report stated.
Data showed that between 2005 and 2007 patients who received PCI care within 90 minutes improved, 42.1 versus 71.8 percent, respectively. These rates for those receiving fibrinolytic medication within 30 minutes improved from 37.9 percent to 50 percent.
For the potentially avoidable condition of congestive heart failure (CHF), rates of ED visits for the conditions were significantly higher in the South than in the Northeast, but the West had lower rates.
The rehospitalization rates associated with this condition ranged from $8,058 to $12,908 for patients aged 18 to 64.
“We need to accelerate the pace of quality improvement, especially related to patient safety. Barriers to quality healthcare, such as uninsurance, need to be overcome,” the reported concluded. “Providers need to be empowered with HIT and training. Community partnerships that bring together all the stakeholders who can make or break a quality improvement initiative need to be created and maintained.”