A Few Hospitals on List Have Poor Heart Attack Survival Rates
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Reviewed By Louise Chang, MD
July 9, 2007 -- Most, but not all, hospitals ranked as 'America's best' by a national magazine also rank high in survival among heart attack patients, a new analysis shows.
Heart attack patients treated at hospitals identified as the nation's best for heart care by the publication U.S. News and World Report tended to have lower 30-day mortality rates than patients treated at nonranked hospitals.
But more than a few nonranked hospitals had some of the highest heart attack survival rates, and a handful of highly rated hospitals had some of the worst survival numbers.
The U.S. News & World Report ranking relies heavily on an institution's reputation among health care professionals and on an institution's size and infrastructure.
Yale University cardiologist Harlan Krumholz, MD, who co-authored the new analysis, says these measures are less important than assessments of specific treatments given to patients and patient outcomes.
"We have an increasing number of ways to evaluate hospitals, but consumers need to understand that these tools are still very limited," Krumholz tells WebMD.
America's Best Hospitals?
Krumholz, Oliver Wang, MD, and Yale colleagues assessed death rates among heart attack patients treated during 2003 at the 50 best heart hospitals in the country, according to the U.S. News & World Report ranking.
They compared these rates to those of heart attack patients treated at about 3,800 unranked hospitals during the same year. They used Medicare data of patients older than 65.
After other factors influencing survival were accounted for, ranked hospitals were found to have slightly lower 30-day death rates among heart attack patients than nonranked hospitals (16% vs. 18%).
Thirty-five ranked hospitals (70%) were among the one-fourth of hospitals with the fewest heart attack deaths during the period, and four (8%) were among the one-fourth of hospitals with the highest number of deaths.
Overall, roughly a third of the ranked hospitals fell outside of the quarter of hospitals with the least deaths.
The study is published in the July 9 issue of the journal Archives of Internal Medicine.
"The U.S. News ranking is a composite that incorporates a lot of different information, but it doesn't necessarily identify hospitals that perform specific tasks best, such as treating heart attack patients," Krumholz says.
Best Hospital Measures Evolving
Eric D. Peterson, MD, who directs cardiovascular research at the Duke University Clinical Research Institute, agrees that the public is best served by ratings that place more weight on specific patient outcomes.
"The field of hospital quality measurement is evolving and we are learning more about what we ought to be measuring," Peterson tells WebMD. "Direct measures of care and outcomes tell us the most about hospital performance."
In an editorial accompanying the Yale study, Peterson and Duke colleague Sean Michael O'Brien, PhD, write that increased emphasis on hospital accountability has had a positive impact on patient care, even if these efforts are far from perfect.
They called on those who run the nation's hospitals to look beyond potentially flawed quality rankings.
"They need to realize that regardless of their true rank, the goal should not be to merely beat their peers in the rating but to strive for optimum performance," they write. "In this type of quality competition, the real winners are the patients."
SOURCES: Wang, O.J. Archives of Internal Medicine, July 9, 2007; vol 167(13): pp 1345-1351. Harlan M. Krumholz, MD, professor of cardiology, Yale University School of Medicine, New Haven, Conn. Eric D. Peterson, MD, professor of medicine, Duke University; director of cardiovascular research, Duke Clinical Research Institute, Durham, N.C.
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