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Heart Disease/Stroke

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A hospital's experience with primary angioplasty affects its survival rate for heart attack patients

Heart attack patients who are treated at hospitals experienced in performing primary angioplasty (the opening of blocked arteries by inflating a balloon catheter) have higher survival rates than patients treated at hospitals that perform few of the procedures. Researchers from the University of Alabama at Birmingham found that patients treated at experienced hospitals—that have performed large numbers of primary angioplasty procedures annually—had a 28 percent lower mortality rate for primary angioplasty than patients treated at less experienced hospitals. This equals 2 fewer deaths per 100 patients treated. The study was funded in part by the Agency for Healthcare Research and Quality (HS08843).

The researchers also studied heart attack patients who received thrombolytic drugs (medications that break up clots to restore blood flow in arteries). In contrast to the findings for primary angioplasty, there was no statistically significant difference in the relationship between hospital experience and patient survival rates.

One potential explanation for the inverse relation between the volume of primary angioplasty procedures and in-hospital mortality may be that physicians improved their skills through practice, according to the researchers. Also, high-volume hospitals have systems in place that help them apply the procedures to heart attack patients faster, perhaps contributing to an increase in survival rates. In contrast, resources and the expertise required for the proper administration of thrombolytic drugs are less technical compared with those required for the proper performance of primary angioplasty. In conclusion, the researchers note that all centers that treat heart attack patients should develop clear-cut reperfusion protocols in order to minimize indecision in choosing between alternative treatments.

See "The volume of primary angioplasty procedures and survival after acute myocardial infarction," by John G. Canto, M.D., M.S.P.H., Nathan R. Every, M.D., M.P.H., David J. Magid, M.D., M.P.H., and others in the May 25, 2000, New England Journal of Medicine 342, pp. 1573-1580.

Editor's Note: Select for a second article arising from the same AHRQ grant (HS08843); Dr. Canto is first author of this article as well.

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