Online Hospital Comparison Flawed: Doesn't Measure Angioplasty for Heart Attack

external sites:
Hospital Compare
-- U.S. Dept. of Health & Human Services

Door-to-Balloon Alliance
-- American College of Cardiology

June 22, 2007 --CMS (The Centers for Medicare & Medicaid Services) launched the latest update to its Hospital Compare web site yesterday, for the first time publishing mortality comparisons for both heart attack and heart failure for 4,477 U.S. hospitals. The publication of any official data rating healthcare is welcomed, but unfortunately, for patients suffering from heart disease, the data doesn't reveal much.

Burt Cohen, Editor-in-Chief of Angioplasty.Org, explains:

Angioplasty is considered the primary treatment for acute myocardial infarction, or heart attack. Opening up a blocked artery that is stopping the blood flow during the heart attack will stop the heart attack in its tracks -- relieving the pain and, more importantly, preserving the heart muscle. If the heart muscle can be saved, then the patient after the heart attack is pretty much the same as the patient before the heart attack. But this must be done quickly. Current recommendations state that patients need to be on the catheterization lab table, getting their angioplasty, no more than 90 minutes after arriving at the hospital. This is commonly known in the profession as "door-to-balloon time".

The Hospital Compare web ratings include a "Care Measure" titled "Percent of Heart Attack Patients Given PCI Within 90 Minutes Of Arrival". The problem is that for virtually every one of the 4,477 hospitals, the web site states:

The number of cases is too small (n < 25) for purposes of reliably predicting hospital performance, OR
"0 patients": This hospital treated patients in this condition, but no patients met the criteria for inclusion in the measure calculation.

Angioplasty.Org used the CMS web site to look at a number of hospitals, well-known for their sophisticated, high volume and verifiable "door-to-balloon time" programs -- hospitals like Lenox Hill Hospital in New York that, according to Dr.Gary Roubin, often boast "door-to-balloon times" of 30 minutes, or hospitals like Minnesota's Abbott Northwestern, which has developed a helicopter-based system which delivers patients from rural areas to the cath lab in Minneapolis within the 90 minute window. Angioplasty.Org researched well-known hospitals throughout the United States and all of these hospitals received one of the two "error" messages noted above -- which is completely inexplicable since these hospitals treat hundreds of heart attack victims.

There is obviously a problem with the database that Hospital Compare has compiled, says Cohen. Perhaps the data collection is still in its early phases and incomplete. There are many hospitals in the U.S. that have made emergency angioplasty a priority. But for some reason, the Hospital Compare web site completely ignores these institutions. The problem is that patients will look at this data and get a very skewed picture of what constitutes the best place to go if you are having a heart attack. He states:

"Looking at the mortality statistics, without any meaningful "door-to-balloon time" data, would lead a patient to conclude that it makes no difference whether they are transported to a hospital that performs angioplasty or not. This would, of course, be a big mistake."

Cohen continues that the overall 30-day mortality statistics for heart attack victims are also not that helpful, since out of 4,477 hospitals nationwide, only 17 rated "Better than U.S. National Rate" while 7 rated "Worse than U.S. National Rate". That means only 24 hospitals were "No different than U.S. National Rate", i.e. your chances of finding that a specific hospital is anything other than "average" are only a mere 1/2 of one percent.

The Hospital Compare web site and database hold promise for the compilation and display of more specific data for the future. However, patient looking for the best hospital to go to for the treatment of the heart attack may need to use other sources.

Queries about the data discrepancies noted in this article were made by Angioplasty.Org to the creators of the Hospital Compare web site. As of this posting, Angioplasty.Org has not received a reply.