Get With The Guidelines Research Featured at National Quality Meeting

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May 21, 2010, 06:31 ET

WASHINGTON, May 21 /PRNewswire-USNewswire/ -- Researchers from top academic centers around the world are gathering in Washington, D.C. this week to discuss opportunities, projects, policies, and research important for measuring and improving quality of care and health outcomes for people with cardiovascular disease and stroke. Among the research to be presented at the Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke 2010 Scientific Sessions, are studies from the American Heart Association/American Stroke Association's Get With The Guidelines® quality improvement initiatives.

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This research identifies gaps in quality of care and opportunities for improvement, as well as Get With The Guidelines' impact on the hospital care of heart failure and stroke patients.

Launched in 2000, the program is now carried out through four modules – Get With The Guidelines – Heart Failure, Get With The Guidelines – Stroke, Get With The Guidelines – Outpatient and ACTION Registry – Get With The Guidelines (formerly Get With The Guidelines – Coronary Artery Disease), with several new initiatives on the horizon.

One or more of the hospital-based modules are being implemented in more than 1,600 acute care hospitals across the United States. More than 2.2 million patient records have been entered into the patient database, allowing for a rich source of research materials for better understanding the care of heart disease and stroke.

"While working diligently to improve the care delivered to patients at their own hospitals, each participating site is helping to build this living library of information about patterns of care in America," said Lee H. Schwamm, M.D., chair of the Get With The Guidelines steering committee and director of TeleStroke and Acute Stroke Services at Massachusetts General Hospital in Boston. "By bringing together experts in clinical care, clinical research, statistics and quality improvement science, the American Heart Association has been able to leverage this enormous dataset necessary to provide new insights into disparities in care delivery, trends in patient and disease characteristics, and opportunities for improvement. In addition, Get With The Guidelines provides valuable, detailed information about how well we as a country are doing at delivering evidence-based care to patients with heart disease and stroke."

The following are highlights of Get With The Guidelines research being presented this week:

Quality initiatives must focus on reducing door-to-imaging times for stroke patients

National guidelines recommend that patients presenting with acute stroke symptoms should undergo brain imaging within 25 minutes of emergency department arrival because delays in the imaging could prevent or reduce the effectiveness of proven stroke treatments.

Researchers in this study found that brain imaging is not performed within the recommended 25 minutes in the majority of cases, and quality improvement initiatives should focus on reducing door-to-imaging times. They identified specific areas that seem to predict whether patients are more or less likely to receive the imaging within the time period.

The researchers reviewed data from 221,538 patients in the Get With the Guidelines – Stroke program from 2003 through 2009. They found that brain imaging was performed within 25 minutes in only 21.6 percent of patients (a rate which increased slightly from 2003 to 2009).

The following variables were associated with less likelihood of brain imaging being completed within 25 minutes of arrival:

age greater than 70 years;
female gender;
African American race;
history of diabetes;
carotid stenosis (carotid artery narrowing);
peripheral vascular disease (diseases of the blood vessels outside the heart and brain);
smoking;
use of antihypertensive or diabetic medications;
symptom onset in another acute care or chronic care facility;
transportation to hospital other than ambulance;
hospital location in the Northeast region.

Patients who had a history of atrial fibrillation/flutter or used cholesterol-reducing medications had a higher likelihood of brain imaging completion within 25 minutes.

Abstract 8 - Door-to-imaging Times in Patients Presenting With Acute Stroke

Presented May 20, 2010, 3 p.m. CT/4 p.m. ET

Too many patients hospitalized with heart failure are discharged to skilled nursing facilities, presenting an opportunity for quality improvement

Nearly a quarter of patients hospitalized for heart failure are discharged to a skilled nursing facility, according to new research. Researchers say these patients face a high risk for death or rehospitalization within six months, and these results highlight possibilities to improve quality of care processes and outcomes for this patient population.

Researchers looked at discharge location and clinical outcomes for Medicare beneficiaries age 65 or older following admission for heart failure from 2003 to 2006 in hospitals participating in the Get With The Guidelines - Heart Failure (GWTG-HF) quality improvement initiative.

Among 16,657 patients at 125 hospitals, 22.4 percent were discharged to a skilled nursing facility, with rates of discharge ranging from 14 percent to 28 percent among facilities. The highest rates of discharge to a skilled nursing facility were in the Northeast and lowest in the South.

Among the factors that made it more likely for a heart failure patient to be discharged to a skilled nursing facility were:

advanced age;
depression;
being female;
having had prior stroke;
low blood pressure;
anemia, diabetes or vascular disease.

In the 180 days following hospital discharge, death occurred in 39.5 percent of patients who were discharged to a skilled nursing facility versus 17.8 percent who were not discharged to a skilled nursing facility. Rehospitalization occurred in 62.6 percent of those discharged to a skilled nursing facility versus 56.4 percent of those who were not.

Abstract P175 - Discharge to a Skilled Nursing Facility and Subsequent Clinical Outcomes among Older Patients Hospitalized for Heart Failure

Presented May 20, 2010, 4p.m. CT/5 p.m. ET

Women hospitalized with heart failure less likely than men to receive all quality of care measures, have longer hospital stays

Compared to men, women hospitalized for heart failure received similar quality of care for most, but not all, quality measures and they tend to stay in the hospital longer than their male counterparts, according to a new study.

Researchers analyzed 99,841 heart failure admissions from January 2005 to June 2009 at 248 hospitals participating in Get With The Guidelines – Heart Failure. They found that half of those patients were women who were hospitalized for heart failure and were more likely than men to be older and have high blood pressure. Women were less likely to have coronary artery disease or renal insufficiency (poor kidney function).

Regarding the acute care they received: Female patients were less likely than male patients to have their ejection fraction measured in the hospital. The ejection fraction is an important measurement in determining how well the heart is pumping out blood and in diagnosing and tracking heart failure. Women were also less likely to receive medication for irregular heartbeat, or atrial fibrillation, or an implantable cardioverter defibrillator (ICD). Women were as likely to receive education, certain medications and smoking cessation counseling. Although the average length of hospital stay in the study was four days, women were more likely than men to be hospitalized longer than four days and longer than seven days.

Abstract P188 - Quality of Care and Outcomes in Women Hospitalized for Heart Failure

Presented May 20, 2010, 4p.m. CT/5 p.m. ET

Additional Get With The Guidelines studies include:

Abstract 9 – Are We Targeting the Right Economic Metric for Heart Failure? Association of Hospital 30-Day Heart Failure Readmission Rates and Total Inpatient Days

Presented May 20, 2010, 3:15 p.m. CT/ 4:15 p.m. ET

Abstract P32 – Potential Underuse of Antidepressants in Post-stroke Depression: Data from the AVAIL Registry

Presented May 20, 2010, 4p.m. CT/5 p.m. ET

Abstract P34 – Hospital Level Variation in Clinical Outcomes for Medicare Beneficiaries Hospitalized with Ischemic Stroke