More than 200,000 patients are treated when their heart stops in the hospital every year, and a study published Wednesday suggests that whether they develop brain damage or die as a result depends on which hospital they are staying in.
The findings, published Wednesday in JAMA Cardiology, show that hospital vary significantly in how they deliver care to patients who are having cardiac arrests. If all hospitals followed protocol at the level of those who follow it the most closely, study authors estimate that as many as 24,200 lives would be saved each year.
Dr. Monique Anderson, lead study author and assistant professor of medicine in the division of cardiology at Duke University, says studies like this could help better inform what kinds of quality measures are taken into account for hospitals in evaluating how they should be reimbursed for care, and about whether they should be required to report the data publicly.
“Many hospitals would say, “We don’t need another measure.’ But our study shows there is significant variability,” Anderson says.
Often, patients who have cardiac arrests are in the hospital for reasons other than heart problems. Early treatment for a cardiac arrest is important because it can prevent or limit damage to the heart muscle, according to the National Institutes of Health’s National Heart, Lung and Blood Institute. After a cardiac arrest, a patient can have difficulties thinking, become disabled, fall into a coma or become brain dead – and the worst outcomes are more likely when protocol for heart attacks isn’t followed correctly or in a timely manner.
To conduct the study, researchers used data from more than 35,000 patients who were treated at 261 hospitals in the U.S. from Jan. 1, 2010, to Dec. 31, 2012. They examined whether patients survived the cardiac arrest, and if so, whether they had suffered any brain damage when they were discharged.
They also looked at whether hospitals followed guidelines created by the American College of Cardiology and the American Heart Association for caring for patients with cardiac arrests. This includes having a nurse or a telemetry monitor witness a cardiac arrest. Anderson explains that this factor also helps to demonstrate that a hospital has a better nurse-to-patient ratio to have witnessed the cardiac arrest. The monitors are used for some patients, including those in intensive care, as a way to keep track of heart rate and rhythm.
After a cardiac arrest is detected, the guidelines specify that hospital staff insert a tube into a patient’s mount to provide oxygen, carry out chest compressions no more than one minute apart, and use a defibrillator to shock the heart less than two minutes after inserting the oxygen tube. If a pulse isn’t detected after five minutes, the guidelines specify that the drugs epinephrine or vasopressin be administered for help with blood pressure.
Hospitals have different levels of ability to follow protocol when a patient has a heart attack, and those who follow the steps the way they are supposed to are more likely to have more patients survive and have healthier brain function, according to the study’s authors.
In particular, patients who were shocked by a defibrillator within two minutes were 50 percent more likely to survive, compared with those who had delays.
“A lot of hospitals are doing OK, but a lot of hospitals can do better, and others can really do better,” Anderson says.