Hospital certification program for cardiovascular, stroke care needed

"Our goal is to continue to reduce deaths from cardiovascular disease and stroke by 20 percent by 2020," said Ralph Sacco, M.D., M.S., president of the American Heart Association and co-author of the advisory. "To do so we have to make sure hospitals are providing the highest quality care to patients to improve their outcomes."

A comprehensive certification program would help ensure that hospitals consistently provide proven therapies and achieve better outcomes -- and recognize those that do, said Gregg C. Fonarow, M.D., first author of the advisory and professor of cardiovascular medicine of the University of California, Los Angeles.

"We want this to be objective, unbiased and really meaningful," Fonarow said. "Many studies show that the quality of care for cardiovascular disease and stroke can vary substantially depending on the hospital."

For example, hospitals differ widely in when they administer the preferred reperfusion therapy to unblock an artery after a severe type of heart attack known as ST-segment elevation myocardial infarction (STEMI); when and whether they give appropriate medicine after stroke; whether they give patients a statin to prevent recurrent illness; and whether they refer patients for cardiac or stroke rehabilitation.

"Being able to distinguish centers that consistently provide excellent cardiovascular disease and stroke care could mean the difference between patients receiving or not receiving therapies that are highly effective and will help improve the likelihood of surviving an acute cardiovascular illness -- reducing the likelihood of being disabled or having another event," Fonarow said.

Some programs that assess hospitals are linked to better quality of care and improved patient outcomes, according to research. "But data are mixed and often differences aren't great," Fonarow said. "It can be difficult sorting through these programs, and there isn't really, from a trusted source, a single certification program that consumers, insurers, clinicians and the public can use to understand which hospitals are providing exceptional overall cardiovascular and stroke care."

A comprehensive certification program would build on the American Heart Association/American Stroke Association's Get With The Guidelines performance improvement and recognition programs. Since the association launched the programs a decade ago, more than 1,500 hospitals have implemented them in areas including stroke, heart failure and resuscitation.

The association has also partnered with The Joint Commission, a national hospital accrediting body, to provide advanced hospital certification in heart failure care and certification of hospitals as Primary Stroke Centers.

"We know that for stroke care, stroke certification has really made a difference," said Sacco, chairman of the department of neurology at the University of Miami's Miller School of Medicine.

Hospital stakeholders want a credible program with meaningful ratings that recognize high standards and operational excellence, according to a small AHA/ASA survey.

"The American Heart Association/American Stroke Association is the ideal group to help usher in new programs for hospital certification because of our development of evidence-based guidelines and the expertise of our professional volunteers in diagnosis and treatment of cardiovascular disease and stroke," Sacco said.

Annually, there are about 6.2 million cardiovascular and 730,000 stroke hospitalizations and 7.2 million cardiac and vascular procedures performed. Cardiovascular disease accounts for 831,000 deaths -- more than 34 percent of all deaths -- each year.

Other authors are Tammy Gregory; Meagen Driskill, R.N., M.B.A.; Mark D. Stewart, M.P.H.; Craig Beam, C.R.E.; Javed Butler, M.D., M.P.H.; Alice K. Jacobs, M.D.; Neil M. Meltzer, M.P.H.; Eric D. Peterson, M.D., M.P.H.; Lee H. Schwamm, M.D.; John A. Spertus, M.D.; Clyde W. Yancy Jr., M.D.; and Gordon F. Tomaselli, M.D. Author disclosures and sources of funding are on the manuscript.