Improvements in Heart Attack and Heart Failure Patient Safety Serve as Examples for Other Conditions | Cardiology Magazine

Although we know more today about health care than ever before, complications during hospital stays remain a major challenge in hospitals across the country. No matter how small, complications that arise during hospital stays are costly and can increase a patient’s risk of death. But according to a recent study, we’ve made some headway in recent years in improving patient safety in U.S. hospitals, particularly in cardiovascular care.

The results of a study we conducted as part of a team led by Yun Wang, PhD, on this topic were recently published in the New England Journal of Medicine. The study analyzed the medical records of more than 61,500 Medicare patients hospitalized between 2005 and 2011 to see if patient safety improved over this time period. Investigators used the Medicare Patient Safety Monitoring System data abstracted from medical records on 21 adverse events in patients hospitalized in the U.S. between 2005 and 2011 for acute myocardial infarction, congestive heart failure, pneumonia or conditions requiring surgery. Trends in the rate of occurrence of adverse events for which patients were at risk, the proportion of patients with one or more adverse events, and the number of adverse events per 1,000 hospitalizations were then assessed. The study included a total of 61,523 patients hospitalized for acute myocardial infarction (19 percent), congestive heart failure (25 percent), pneumonia (30 percent) and conditions requiring surgery (27 percent).

After comparing rates of complications during this six-year period, researchers found that risk of complications significantly decreased among heart attack and heart failure patients. However, there were no significant changes in risk of complications among patients hospitalized for pneumonia or surgery. From 2005 through 2011, among patients with acute myocardial infarction, the rate of occurrence of adverse events declined from 5.0 percent to 3.7 percent, the proportion of patients with one or more adverse events declined from 26.0 percent to 19.4 percent, and the number of adverse events per 1,000 hospitalizations declined from 401.9 to 262.2. Similarly, in patients with congestive heart failure, the rate of occurrence of adverse events declined from 3.7 percent to 2.7 percent, the proportion of patients with one or more adverse events declined from 17.5 percent to 14.2 percent, and the number of adverse events per 1,000 hospitalizations declined from 235.2 to 166.9. Patients with pneumonia and those with conditions requiring surgery had no significant declines in adverse-event rates.

On one hand, we are encouraged by these findings. Between 2001 and 2011, the government spent roughly 532 million dollars for research on patient safety and a number of new laws were passed to improve patient safety. It’s clear that these efforts were not in vain, as we’ve seen significant improvements in patient safety for heart attack and heart failure patients during a time when national organizations like the ACC have taken the lead in driving evidence-based care and tracking this care systematically through the NCDR.

Still, further efforts to improve patient safety across the board are required. Surgery and pneumonia are two of the most common causes of hospitalization and the more we can improve patient safety, the better. Researchers hope that by closely monitoring rates of complications, we can continue to improve patient safety for all hospital patients, regardless of their health condition.


Article written by By JoAnne M. Foody, MD, FACC and Harlan M. Krumholz, MD, SM, FACC. Foody is a co-author of the study and editor-in-chief of CardioSmart. Krumholz is a co-author of the study, editor-in-chief of the ACC’s Lifelong Learning Portfolio and a member of the ACC Board of Trustees.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Myocardial Infarction, Pneumonia, Heart Failure, Patient Safety, Medicare, Hospitalization, Medical Records, United States, Cardiology Magazine, ACC Publications


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