Advanced Technology for MI
One type of advanced technology available for MI is Percutaneous Coronary Intervention (PCI). This procedure is performed to open blocked coronary arteries caused by coronary artery disease and to restore arterial blood flow to the heart tissue without open-heart surgery. Certain patients will benefit from rapid reperfusion (re-entry of blood into area where flow has been reduced) through the use of PCI. PCI is a procedure that uses a balloon tipped catheter-tube, which is inserted into a leg artery and then advanced to the heart in order to open blocked arteries that cause heart attacks.
According to The American College of Cardiology and American Heart Association Guidelines for The Management of Patients with Acute Myocardial Infarction, PCI may be used as an alternative to thrombolytic therapy (medication that disrupts blood clot formation) in patients where this medication is contraindicated. PCI may also be used in addition to thrombolytic therapy.
At Brigham and Women's Hospital, PCI is available 24 hours a day, seven days a week, and is requested directly by the Emergency Department when appropriate. To see detailed quality measures about PCI, please click here.
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Inpatient Mortality
Mortality rate (measured as a percentage) provides general information about the quality of care delivery, and can be an important quality indicator. However, some hospitals care for patients with a greater severity of illness and therefore may have a higher mortality rate. Based on a large sample of university hospitals (data from the University Healthsystem Consortium, aka UHC), the national average mortality rate for MI is 8.7%. Because BWH is a recognized center of care for complicated patients, our estimated mortality rate is 11.2% (as estimated by UHC), much higher than the national average.
The inpatient mortality rate for heart attack at Brigham and Women's Hospital is not significantly different than the expected rate. All rates refer to the 12-month period ending 6/30/07.
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30-Day All Causes Mortality Rate
The Centers for Medicare and Medicaid (CMS) have done an analysis of 30-day all cause mortality, following an admission for heart attack. CMS derived the 30-Day Risk-Adjusted Mortality measures from their own data about patients on Medicare and the hospitals that treat them. Hospitals were classified as "Better", "Worse", or "No Different" than the U.S. National Rate. For information about other hospitals' performance, go to the Hospital Compare website.
Brigham and Women's Hospital was rated "No Different" than the U.S. National Rate for hospital 30-day risk-adjusted heart attack mortality.
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Angiotensin Converting Enzyme Inhibitor (ACEI) or Angiotensin Receptor Blocker (ARB) for Patients with Left Ventricular Systolic Dysfunction (LVSD)
The left ventricle is the part of the heart that holds and pumps blood to other vital organs. A measure called the left ventricular ejection fraction or LVEF is used to check for damage due to heart attacks and other conditions. The LVEF value for a person with no heart damage is usually around 60 percent or greater. Systolic dysfunction (condition that causes reduced pumping ability of the heart's left lower ventricle) represents reduced pumping ability of the heart.
ACEI's are a group of medications that relax blood vessels and make it easier for the heart muscle to pump blood to vital organs. ARB's are a similar group of medications, and both are recommended by the Joint Commission for Accreditation of Healthcare Organizations as important tools for reducing mortality in heart attack survivors who have LVSD.
A scientific statement from the American Heart Association Council on Clinical Cardiology Research indicates those heart attack survivors who have LVSD should be placed on an ACEI or ARB. These medications reduce the chance of death and reduce disease symptoms after a heart attack (Circulation, May 24, 2005: 111(20); 2699-2710).
96% of eligible heart attack survivors at Brigham and Women's Hospital have received a discharge prescription for an ACEI or ARB in 2007 (fiscal year to date).
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Aspirin at Admission and Discharge
To work properly, the heart muscle requires constant oxygen and nutrients, which travel through blood vessels. A narrowed blood vessel of the heart (coronary artery) diminishes the oxygen and nutrient delivery to the heart. If a blood clot forms in a coronary artery it can cut off the oxygen supply completely and cause a heart attack (myocardial infarction). Aspirin helps to prevent blood clot formation.
Multiple research studies over the past ten years provide strong evidence that aspirin and certain platelet inhibitors (drugs that keep blood platelets from sticking together) decrease the risk of re-closing a narrowed artery (restenosis) and death after a heart attack. According to the Joint Commission on Accreditation of Healthcare Organizations, persons with a suspected heart attack should receive aspirin within 24 hours before or after hospital arrival. The American College of Cardiology/American Heart Association Task Force on Practice Guidelines found Class I evidence (highest level of scientific support) for taking aspirin indefinitely after a heart attack (Circulation, September, 2000: 102(10); 1193-1209 ).
100% of heart attack survivors at Brigham and Women's hospital received aspirin within 24 hours of arrival, and upon discharge, unless contraindicated, in 2007 (fiscal year to date).
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Beta-Blocker at Admission and Discharge
Beta blockers are a group of medications that block the stress hormone adrenaline, creating health benefits for heart attack survivors by blocking the harmful effects of adrenaline and slowing the pulse rate. Multiple studies show that early use of this medication consistently reduces the risk of death and decreases damage to the heart muscle (Circulation, May, 2005:111 (20); 2699-2710). For heart attack survivors, starting beta blockers (group of medications that block the stress hormone adrenaline) at or before hospital discharge has been shown to reduce death and disability (American Heart Journal, December, 2004: 148(6); 944-50).
There are many different types of beta blockers. Your physician will prescribe one that will best suit your needs. Beta blockers are not for everyone, however. Some heart attack survivors may not receive a beta blocker due to other health conditions such as lung disease or slow pulse rate.
100% of heart attack survivors at Brigham and Women's hospital have received a beta blocker within 24 hours of arrival, and a prescription upon discharge, unless contraindicated, in 2007 (fiscal year to date).
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Smoking cessation
Smoking is a modifiable risk factor for heart disease. National guidelines strongly recommend smoking counseling to help heart attack survivors who smoke to quit smoking. (National Cancer Institute Prevention and Cessation of Cigarette Smoking: Control of Tobacco Use) Tobacco Cessation Guidelines from the United States Department of Health and Human Services provide helpful tips on smoking cessation for patients.
At Brigham and Women's Hospital, in 2007 (fiscal year to date), 96% percent of eligible heart attack survivors received referrals for smoking cessation counseling prior to discharge.
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Quality Measures for Other Cardiovascular Procedures & Diseases:
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