In an article appearing today in JAMA, researchers report that an assessment of data from a Swedish national registry of all patients with heart attacks found that death rates decreased as hospitals began to adopt recommended procedures and therapies. For example, between 1996 and 2007, the proportion of patients who were treated with a procedure to open up blocked coronary arteries increased from 10% to 84% and the number of those who were prescribed a statin to lower their cholesterol level increased from 23% to 84%. During the same period, the proportion of patients dying within 30 days of their heart attack decreased from 15.0% to 8.6%; the proportion dying within 1 year decreased from 21.0% to 13.3%.
Tomas Jernberg, MD, PhD, of the Karolinska University Hospital in Stockholm and lead author, explains:
“There is a large variation on how quickly hospitals adhere to guidelines and adopt new treatments, and this variation is greatest at the introduction of new treatments. This is an important finding and shows that quality improvement programs need to identify this kind of variation and try to minimize it.
“On the hospital level, the lack of adherence to guidelines may be caused by poor routines to identify and adopt new treatments. On a doctor level, it may be that the doctors are not adequately updated, or they just don’t agree with the guidelines.”
“It is difficult for hospitals to initiate guideline therapies, but we have this registry allowing hospitals to interact with it online to see how well they adhere to the guidelines. Most hospitals want to adhere, and every year we publish a report based on the registry data with the hospitals’ names appearing next to the results. That gives them motivation to improve their adherence to the guidelines.”