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Teaching hospitals provide better care for older heart attack patients

Elderly patients treated for heart attack at teaching hospitals are more likely to survive and receive better quality care than those treated at hospitals that do not train physicians, according to a nationwide study supported in part by the Agency for Healthcare Research and Quality (HS09446 and HS08843).

The University of Alabama at Birmingham researchers who conducted the study found that Medicare patients aged 65 and older who received care for myocardial infarction at teaching hospitals were more likely to still be alive 2 years after being discharged—the maximum followup period studied—than similar patients who were treated at non-teaching hospitals. Further analysis revealed that the lower heart attack death rate found for patients treated in teaching hospitals could be attributed to their receipt of better quality of care.

This is the most extensive and in-depth study to date of quality of patient care and mortality as they relate to hospital teaching status, according to Catarina I. Kiefe, M.D., Ph.D., one of the study's senior authors. Dr. Kiefe and her colleagues found that the patients of major teaching hospitals—academic medical centers with more than one intern for every 10 patients—were more likely to be given aspirin during their stays, if appropriate, than patients treated in non-teaching hospitals (91.2 percent vs. 81.4 percent). Aspirin helps prevent blood clots, which can cause a repeat heart attack or stroke.

The major teaching hospital patients also were more likely to be given beta-blockers and angiotensin-converting enzyme inhibitors (ACE inhibitors) upon discharge, when appropriate, (48.8 percent vs. 36.5 percent and 63.6 percent vs. 58 percent, respectively). Beta-blockers slow the heart rate and reduce contractions of the heart muscle; ACE inhibitors reduce constriction of blood vessels. Usage rates for these drugs at minor teaching hospitals—facilities with one or fewer interns for every 10 patients—were lower than those of major teaching hospitals but higher than the rates for non-teaching facilities.

The study found no significant differences between teaching and non-teaching hospitals in the use of angioplasty—an invasive procedure for opening clogged arteries—or thrombolytic drugs, which are used to dissolve blood clots, with the relatively small number of patients who were ideal candidates for these treatments.

The study was based on Medicare data on 114,129 randomly selected patients from all 50 States who were treated for heart attack between February 1994 and July 1995.

Details are in "Teaching versus non-teaching hospitals: Mortality and quality of care for Medicare patients with acute myocardial infarction," by Jeroan J. Allison, M.D., Dr. Kiefe, Norman W. Weissman, Ph.D., and others, in the September 13, 2000, issue of the Journal of the American Medical Association 284(10), pp. 1256-1261.

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