Elderly patients treated for heart attack at teaching hospitals are more likely to survive and receive better quality care than those treated at hospitals that do not train physicians, concludes a nationwide study supported by the Agency for Healthcare Research and Quality (AHRQ) and published in next Tuesday's issue of the Journal of the American Medical Association (JAMA).
The University of Alabama at Birmingham researchers who conducted the
study found that Medicare patients aged 65 and older provided care for
myocardial infarction at teaching hospitals were more likely to still be alive two years after being discharged -- the maximum follow-up period studied -- than were similar patients treated at non-teaching hospitals. Further analysis revealed that most of the teaching hospital patients' lower heart attack death rate was due to having received better quality of care.
"This study underscores the importance of vigorously evaluating the
outcomes and effectiveness of how and where we deliver health care services," said John M. Eisenberg, M.D., AHRQ's director.
"This is just as critical to improving health care quality as studying the outcomes and effectiveness of different medical treatments."
"This is the most extensive and in-depth study to date of quality of
patient care and mortality according to hospital teaching status," said Robert Centor, M.D., a senior author of the study.
The researchers found that the patients of major teaching hospitals --
academic medical centers with more than one intern for every 10 patients --
were more apt to be given aspirin during their stays, if appropriate, than
were the non-teaching hospitals' patients (91.2 percent versus 81.4 percent).
Aspirin helps prevent blood clots, which can cause a repeat heart attack or
The major teaching hospital patients were also more likely to be given
beta-blockers and angiotensin-converting enzyme inhibitors (ACE inhibitors)
upon discharge, when appropriate, (48.8 percent versus 36.5 percent and 63.6
percent versus 58 percent, respectively). Beta-blockers slow the heart rate
and reduce contractions of the heart muscle; ACE inhibitors reduce
constriction of blood vessels.
Usage rates for these drugs at minor teaching hospitals -- facilities with
one or fewer interns for every 10 patients -- were lower than those of major
teaching hospitals but higher than the rates for non-teaching facilities.
The study found no significant differences between teaching and non-
teaching hospitals in the use of angioplasty -- an invasive procedure for
opening clogged arteries -- or thrombolytic drugs, used to dissolve blood
clots, with the relatively small number of patients who were ideal candidates
for these treatments.
The study was based on Medicare data on 114,129 randomly selected patients
from all 50 states who were treated for heart attack between February 1994 to
The study is in the September 13, 2000, issue of JAMA. "Teaching versus Non-Teaching Hospitals: Mortality and Quality of Care for Medicare Patients with Acute Myocardial Infarction," by Jeroan J. Allison, M.D., Catarina I. Kiefe, Ph.D., M.D., Norman W. Weissman, Ph.D., Sharina Person, Ph.D., Dr. Centor and others.