ER strategies reduce heart attack patient deaths

Hospitals using emergency treatment strategies emphasizing evidence-based therapy and better communication among healthcare providers reduced heart attack patient deaths by 19% for up to one year after patient discharge, according to a recent study.

The study, “Acute Coronary Syndrome Emergency Treatment Strategies (ACSETS): Improved Treatment and Reduced Mortality in Patients with Acute Coronary Syndrome Using Guideline-based Critical Care Pathways,” published in the American Heart Journal, demonstrated that collaboration between hospitals and treating physicians to optimize compliance with national guidelines helps patients comply with medication regimens.

The guidelines for care during hospitalization for heart attacks and for post-discharge medications significantly increase the likelihood that patients will continue taking their prescribed medications long after discharge.

“Managed care executives will be interested in knowing that this is a strategy that can help improve outcomes and presumably lower costs for heart attack patients,” according to Mark Cziraky, the study’s co-author and HealthCore vice president of research development and operations.

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

Another takeaway from this study is the importance of therapy continuity for patients and the need for MCOs to work closely with providers to ensure more integrated care. They can also incorporate lessons learned from ACSETS into a value-based insurance design, Cziraky says.

Improvement of the quality of care and reduction of cost of care trend are priority issues for managed care executives.“ACSETS can be used as a model to improve care delivered to patients with heart attacks and to potentially further a wide range of clinical care quality improvement initiatives,” he says.

A coordinated set of order sheets helped guide care from ER admission through discharge from the hospital with consistent evidence-based recommendations for therapy, as opposed to more commonly used ad hoc written orders, according to Cziraky. In addition, a medication discharge sheet with pre-printed medication classes recommended for each patient was presented by a pharmacist prior to discharge from the hospital to ensure that patients were aware of the importance and use of each of their recommended medications. The discharge sheet also answered common patient questions.

Reduce Barriers
ACSETS identified several stumbling blocks that stand in the way of hospitals coordinating care and implementing evidence-based medicine, including:

• Different departments inside hospitals work independently and often don’t transfer the information that is learned about the patient; and

• Nationally accepted guidelines developed from medical research on how to treat patients are often difficult to implement consistently in hospitals due to their very complex operational structures.

“We wanted to see if heart attack patients would have better results if education, communication and coordination across departments were improved,” Cziraky says. “This was the first study to investigate acute coronary syndrome critical care pathway approach in a population of patients encompassing the total acute coronary system management spectrum.

“Part of creating this pathway involved educating the staff members on the use of pre-printed order sheets customized for use in the emergency department, inpatient departments [i.e., CCU, telemetry unit and medical floor] and at discharge to simplify the task of matching the intensity of therapy to each patient’s relative risk,” he adds.

Rather than follow the normal procedure of creating a new order sheet at every patient stop-from the ER to the cardiac care unit to the medical unit and then to discharge-the same set of orders stayed with the patients as they made their journeys through the hospital.

“Physician researchers and hospital representatives also spoke with local insurers to make sure the range of medications commonly prescribed for ACS were easily accessible so that patients would not be faced with an access to medication hurdle after they left the hospital,” he says.