Why did the heart attack and heart failure measures change in Hospital Compare and what do the changes mean?

Answer:

How we measure 'good care' changes as the experts learn more from research. The change in the quality measures for the treatment of heart attack and heart failure for Left Ventricular Systolic Dysfunction (LVSD) is a change to keep quality measures up-to-date with the most recent evidence about effective treatments.

ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are medicines used to treat patients with heart failure, and are particularly beneficial for those patients with heart failure or who have had a heart attack and who have decreased function of the left side of the heart (with LVSD). Early treatment with ACE inhibitors and ARBs for patients who have heart failure symptoms or decreased heart function after a heart attack can also reduce risk of death from future heart attacks. ACE inhibitors and ARBs work by limiting the effects of a hormone that narrows blood vessels, and may thus lower blood pressure and reduce the work the heart has to perform. Since the ways in which these two kinds of drugs work are different and may have different side effects, your doctor will decide which drug is most appropriate for you. If you have a heart attack and/or heart failure, and you have decreased heart function, you should get a prescription for ACE inhibitors or ARBs before you leave the hospital. The rates posted on Hospital Compare in December 2005 reflect how well hospitals provide both of these treatments.

For more specific information about the changes, please see below:

The two quality measures that assess the use of ACE-inhibitors for patients with heart failure or who have had a heart attack have been changed to acknowledge the evolving evidence from recent clinical trials. Although many experts believe that ACE inhibitors should remain the first-line method of treating patients with heart failure, the accumulating evidence of therapeutic benefit indicates that ARBs are an acceptable alternative to ACE inhibitors.

The measures reported on Hospital Compare, beginning with the rates posted in December 2005, assess treatment with either of the two medication classes – ACE-inhibitors or ARBs -- in patients with heart failure or after an acute heart attack who have impairments in the contractile function of the left side of the heart. All such patients should be treated with either an ACE-inhibitor or an ARB unless there is documentation of a specific reason not to use both classes of drugs.

Last Updated: 4/30/2008