Author/Authors :
Adam M. Rogers، نويسنده , , Vijay S. Ramanath، نويسنده , , Mary Grzybowski، نويسنده , , Arthur L. Riba، نويسنده , , Sandeep M. Jani، نويسنده , , Rajendra Mehta، نويسنده , , Anthony C. De Franco، نويسنده , , Robert Parrish، نويسنده , , Stephen Skorcz، نويسنده , , Patricia L. Baker، نويسنده , , Jessica Faul، نويسنده , , Benrong Chen، نويسنده , , Canopy Roychoudhury، نويسنده , , Mary Anne C. Elma، نويسنده , , Kristi R. Mitchell، نويسنده , , James B. Froehlich، نويسنده , , Cecelia Montoye، نويسنده , , Kim A. Eagle and on behalf of the American College of Cardiology Foundation Bethesda MD، نويسنده ,
Abstract :
Background
The American College of Cardiologyʹs Guidelines Applied in Practice (GAP) initiative for acute myocardial infarction (AMI) has been shown to increase the use of guideline-based therapies and improve outcomes in patients with AMI. It is unknown whether hospitals that are more successful in using the standard discharge contract—a key component of GAP that emphasizes guideline-based medications, lifestyle modification, and follow-up planning—experience a proportionally greater improvement in patient outcomes.
Methods
Medicare patients treated for AMI in all 33 participating GAP hospitals in Michigan were enrolled. We aggregated the hospitals into 3 tertiles based on the rates of discharge contract use: 0% to 8.4% (tertile 1), >8.4% to 38.0% (tertile 2), and >38.0% to 61.1% (tertile 3). We analyzed 1-year follow-up mortality both pre- and post-GAP and compared the mortality decline post-GAP with discharge contract use according to tertile.
Results
There were 1368 patients in the baseline (pre-GAP) cohort and 1489 patients in the post-GAP cohort. After GAP implementation, mortality at 1 year decreased by 1.2% (P = .71), 1.2% (P = .68), and 6.0% (P = .03) for tertiles 1, 2, and 3, respectively. After multivariate adjustment, discharge contract use was significantly associated with decreased 1-year mortality in tertile 2 (odds ratio 0.43, 95% CI 0.22-0.84) and tertile 3 (odds ratio 0.45, 95% CI 0.27-0.75).
Conclusions
Increased hospital utilization of the standard discharge contract as part of the GAP program is associated with decreased 1-year mortality in Medicare patient populations with AMI. Hospital efforts to promote adherence to guideline-based care tools such as the discharge contract used in GAP may result in mortality reductions for their patient populations at 1 year.
