New Measures Improve Heart Care

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In the STITCH group, 65 percent of patients reduced their blood pressure to the target level, compared with 53 percent in the guidelines group, a 12 percent absolute change in the proportion of patients who managed to control their hypertension.

While this trial involved mainly single-doctor practices, "the real impact of this study would not be in single practices but with the incorporation of the practices into health-care networks," Feldman noted.

A second study presented at the meeting, and also appearing in the Nov. 28 issue of the Journal of the American Medical Association, found that a statewide program in North Carolina cut the time it took to treat patients having a heart attack either with clot-busting drugs or percutaneous coronary intervention (PCI, also known as angioplasty) by up to 32 minutes.

With a heart attack, the sooner the patient's blocked arteries can be reopened, restoring blood flow to the heart, the better. AHA/American College of Cardiology guidelines recommend that drugs be delivered within 30 minutes and PCI accomplished with 90 minutes of the patient entering the hospital door (known as "door-to-balloon" time).

This program involved improvements such as naming a nurse coordinator and establishing a single telephone number to activate the catheterization lab team, at 65 hospitals throughout the state.

At hospitals that offered PCI, the percentage of patients receiving clot-busting therapy within half an hour improved from 35 percent to 52 percent.

Door-to-balloon times improved from 85 minutes to 74 minutes at PCI hospitals. After the program was established, 72 percent of patients received PCI within 90 minutes.

For patients transferred from a non-PCI hospital to a PCI hospital, door-to-balloon times fell from 160 minutes to 128 minutes, and to 106 minutes for hospitals that routinely transferred for PCI.

Mortality rates were not lowered but the study was not sufficiently powered to see this possible effect, noted study senior author Dr. Christopher B. Granger, director of the cardiac care unit at Duke University Medical Center.