Heartful

Finding top cardiac hospitals is no longer a guessing game

When shopping for the best heart hospital for you and your family, you no longer have to pick one and hope for the best. Statistics are at your fingertips. Places like the Illinois Hospital Report Card and Consumer Guide to Health Care website (www.healthcarereportcard.illinois.gov), launched by the Illinois Department of Public Health in 2009, make it possible to compare the quality of care provided by institutions throughout the state and it’s based on good hard data.

You can easily select two or more hospitals near your home and find data, currently for the time period from April 1, 2009, to March 31, 2010, measuring how well they performed in various areas of healthcare. Among many choices in Chicago, you might want to evaluate the care given to heart attack patients at two major institutions, the University of Chicago (U of C) Medical Center and Northwestern Memorial Hospital.

For overall care of heart attack patients, U of C has a score of 99.06 percent and Northwestern Memorial Hospital 97.93 percent. Both are above the average of all Illinois hospitals, which is 97.71 percent, and the national average of 97.34 percent.

“We track this data in real time rather than waiting to compile it at the end of six months when it’s going to appear on the website,” explains Dr. Bruce Minsky, chief quality officer at the U of C Medical Center. “Heart attack care requires a multidisciplinary approach, and we do internal audits of how people are performing and make changes as needed.”

General heart attack care on the Report Card website is also broken down into the important procedures, medications and other aspects that are crucial in treating a patient successfully and preventing a recurrence. One of the first steps when a heart attack patient arrives at the emergency department is to administer aspirin. Both the U of C Medical Center and Northwestern never fail to do this and score nearly 100 percent on this treatment.

“Aspirin has been shown to prevent death in patients presenting with heart attacks,” says Dr. Charles Davidson, clinical chief of cardiology and medical director of Northwestern Memorial Hospital’s Bluhm Cardiovascular Institute. “It has antiplatelet effects that help in preventing further clot formation at the time of heart attack, which can lead to further blockage of the arteries and extensive damage to the heart muscle.”

Heart attack patients should also receive procedures called Percutaneous Coronary Interventions (PCI), such as angioplasty that open blocked heart vessels. According to national guidelines, PCI should be given within 90 minutes of the patient’s arrival at the emergency department.

“We know that the sooner we can restore blood flow to the heart muscle, the better chance we have of getting recovery of the heart muscle back to normal or near-normal function,” says Davidson. “We just compiled our 2010 data, and we were 100 percent within 90 minutes. It requires a committed team of doctors, nurses, technicians and staff to do this on a 24/7 basis to achieve that. It’s not so hard when a heart attack patient comes in during the middle of the afternoon, but we are able to provide that in the evening, at night, on weekends and holidays.”

The time period between arrival at the hospital and the PCI used to be two hours instead of an hour and a half. “It has been shortened as hospitals have figured out how to tighten up their procedures,” says David Harriman, director of the Center for Quality at U of C. “I would dare say that, largely as a result of the transparency of data, more and more hospitals were able to achieve 120 minutes, and they figured out how to tighten up their procedures, and the bar was reset at 90 minutes.”

Other percentages on the Illinois Report Card include ones for how often aspirin and beta blockers, which prevent the risk of the recurrence of a heart attack, are prescribed when a patient is discharged. In addition, data is provided on how often advice and counseling are given to patients who smoke to help stop their habit. Both Northwestern Memorial Hospital and the U of C Medical Center achieved a score of nearly 100 percent. Harriman explains that this entails much more than suggesting a patient stop smoking and then checking the appropriate box on the form. He says the U of C Medical Center has a full-time social worker on staff who specializes in addiction and change, and the hospital’s residents and doctors are trained to talk to patients about nicotine replacement therapy.

Once you’ve compared information about heart attacks on the Illinois Report Card, you can easily discover the hospitals that provide the best heart attack care. But that doesn’t mean you can choose to go to that hospital if you think you’re having a heart attack because ambulances in Illinois are obligated to take you to the nearest hospital. Davidson points out that plans have been discussed to create a network of heart attack centers in Chicago, similar to ones in Boston and Los Angeles, so that ambulances can take patients to one of the city’s hospitals that has proven its expertise in emergency cardiac care.

It’s crucial to keep in mind that getting to the hospital, any hospital, quickly is of utmost importance. “Every minute counts because we’re trying to save heart tissue,” says Minsky.

Davidson explains, “Although we hold ourselves to the 90-minute standard, we can’t control how long the patient sits at home with symptoms before going to the emergency department. You’d be surprised at how many people deny they’re having a heart attack, and some of those people don’t make it. Half of the deaths from heart attack occur before people ever get to the hospital.

“The idea of going to the hospital soon couldn’t be emphasized enough, not just for heart salvage but for salvage of life.”

But when living with a chronic heart condition or looking to rehabilitate that hard-working muscle, you can choose the best hospital. And that can also be the best choice for life.

Published in Chicago Health Summer 2011