Acute Care/Hospitalization

Study finds that specialty cardiac hospitals are similar to general hospitals in providing high-quality care for certain heart patients

The argument for creating specialized cardiac hospitals to treat patients with heart disease is that these hospitals would be more efficient and provide better care for such patients than would general or unspecialized hospitals. However, a new study does not support that argument.

Researchers compared three classes of hospitals (20 hospitals that performed only cardiac care with 111 competing general hospitals and 48 of U.S. News & World Report's top-ranked hospitals for cardiac care) for compliance with best-practice quality measures in the treatment of patients for heart attack (acute myocardial infarction or AMI) or heart failure (HF). They used quality-of-care data that hospitals are required to provide to the Centers for Medicare & Medicaid Services under a 2003 law—five specific measures of care for patients with AMI and two measures for patients with HF. For each category of measures, the researchers calculated individual and composite scores (the number of patients receiving a particular care divided by the number of eligible patients) for each type of hospital.

Mean scores for all of the measures were high for all of the hospitals; 95 percent of eligible AMI patients and 91 percent of eligible HF patients at the 179 hospitals received the recommended treatments. Differences in a combined measure of cardiac treatment among the three types of hospitals were small, ranging from 93 percent for general hospitals to 94 percent for specialty cardiac hospitals to 96 percent for those with top-rated cardiac programs.

The top-ranked hospitals appeared to perform significantly better than general hospitals on all individual and composite measures, and the study reported no significant differences between the cardiac hospitals and general hospitals. The sample sizes were too small, however, to detect significant differences between the specialty cardiac hospitals and the hospitals with top-ranked cardiac programs.

The study was funded in part by the Agency for Healthcare Research and Quality (HS15571). More details are in "Do specialty cardiac hospitals have greater adherence to acute myocardial infarction and heart failure process measures? An empirical assessment using Medicare quality measures: Quality of care in cardiac specialty hospitals," by Ioana Popescu, M.D., M.P.H., Brahmajee K. Nallamothu, M.D., M.P.H., Mary S. Vaughan-Sarrazin, Ph.D., and Peter Cram, M.D., M.B.A., in the July 2008 American Heart Journal 156(1), pp. 155–160.

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