The American Heart Association 2005 Emergency Cardiovascular Care Guidelines Impact on Myocardial Infarction Mortality in Nevada Hospitals

Abstract

This study investigates the impact of the 2005 American Heart Association (AHA) guidelines on first heart attack (AMI) mortality in Nevada. These guidelines are accepted by the healthcare industry in the U.S. and in many other countries to improve AMI outcomes. The 2005 AHA guidelines for cardiopulmonary and emergency cardiovascular care, which are based on the evidence evaluated by the International Consensus on Science and Treatment Recommendations, aim to decrease mortality and morbidity. The guidelines are based on evidence-based practice and science. This study uses hospital discharge data from full service hospitals in Nevada from 1996 – 2007 to measure the impact of the recommend guideline that percutaneous coronary intervention (PCI) be implemented within 90 minutes from emergency room arrival to the PCI (door-to-balloon). The PCI guideline is expected to decrease AMI mortality. AMI mortality is adjusted for comorbidities and other factors that can influence AMI outcome, and does not include transferred AMI patients. While the proportion of patients receiving PCI increased after the guideline was implemented, mortality did not decrease. This suggests that Nevada healthcare providers do not fully comply with the guidelines for PCI, which causes more heart damage that leads to life threatening complications and death in 2005 to 2007. The results likely represent a lag in implementing the guidelines beyond 2007. PCI utilization appears poor with 39% use in 1996 – 2004 that only increased to approximately 47% in 2005 – 2007.