Cardiovascular Care Better at Top-Ranked Hospitals

Megan Brooks

December 04, 2018

The best hospitals for cardiology, according to US News & World Report's rankings, have better cardiovascular outcomes for common conditions and higher patient satisfaction rates than nonranked hospitals, a new analysis suggests.

"These rankings are very widely watched. Patients use them all the time, but doctors and hospitals are sometimes skeptical whether they really reflect anything," Deepak Bhatt, MD, MPH, Brigham and Women's Hospital and Harvard Medical School, Boston, told theheart.org | Medscape Cardiology.

"What we found was that, indeed, the US News & World Report rankings, at least for common cardiovascular conditions, are an accurate reflection of quality," said Bhatt.

The study was published online November 28 in JAMA Cardiology.

In a national retrospective cross-sectional study, the researchers examined whether the magazine's 50 top-ranked hospitals for cardiology and heart surgery in 2018/19 had better outcomes than 3502 nonranked hospitals for 30-day mortality rates, readmission rates, and patient satisfaction for acute myocardial infarction (AMI), heart failure (HF), and coronary artery bypass grafting (CABG).

In those 2018/19 rankings, the number one hospital on the list of cardiology and cardiac surgery hospitals was Cleveland Clinic Foundation; Brigham and Women's Hospital was ranked number eight.

The researchers found that 30-day mortality rates were significantly lower for all three conditions at the top-ranked hospitals than at nonranked hospitals (P < .001).

30-Day Mortality Rates at Top-Rankes and Nonranked Hospitals
Condition Top-Ranked Hospitals, % Nonranked Hospitals, %
AMI 11.9 13.2
HF 9.5 11.9
CABG 2.3 3.3

Thirty-day readmission rates at top-ranked and nonranked hospitals were similar for AMI (16.7% vs 16.5%; P = .64) and CABG (14.1% vs 13.7%; P = .15), but higher for HF (21.0% vs 19.2%; P < .001).

Patient satisfaction, assessed with the five-point Hospital Consumer Assessment of Healthcare Providers and Systems star rating, was higher at top-ranked hospitals than at nonranked hospitals (3.9 vs 3.3; P = .001).

In an analysis of just the top 50 ranked hospitals, 30-day mortality rates at hospitals ranked 1 to 10 were lower than for hospitals ranked 41 to 50 for AMI and HF but not for CABG. Patient satisfaction was also greater.

Thirty-day readmission rates at top-ranked and lowest-ranked hospitals did not significantly differ for any of the three cardiovascular conditions.

Money Before Patients?

The finding of no association between readmission in general and, in particular, HF readmission at ranked and nonranked hospitals raises concern that this might not be an adequate metric to gauge the quality of care at hospitals, Bhatt told theheart.org | Medscape Cardiology.

"Measuring readmission for HF or other cardiovascular, or even noncardiovascular conditions, is important because we want to see if we can reduce readmissions; that's a worthy goal," he said.

"What is potentially problematic is the financial penalties exacted on hospitals and healthcare systems if their hospitalization rate for HF is too high. This potentially creates a perverse incentive for healthcare systems to behave in ways that aren't necessarily optimized for patient care," said Bhatt. "That's putting money before patients."

Commenting on the findings for theheart.org | Medscape Cardiology, Ben Harder, chief of health analysis at US News & World Report, called these new findings "reassuring."

"It's encouraging to see that the researchers confirmed a positive relationship between hospital quality, as defined by US News in our Best Hospitals rankings, and lower mortality rates in multiple cardiovascular services," he said. "It's also reassuring the researchers found a link between US News–defined hospital quality and patients' ratings of their hospital experience."

Echoing Bhatt, Harder said the finding that readmission rates do not correlate with hospital quality is also important.

"While US News doesn't use readmission in the rankings the researchers examined, the federal government does use readmission as a quality measure [and] assesses substantial financial penalties on hospitals with elevated readmission rates," said Harder. "The new study suggests this federal policy may be wrong-headed at least for certain common cardiovascular services, such as heart failure treatment."

"Our internal data at US News are consistent with their finding," he added. "Readmission appears to be a decent quality measure in surgical care, but not as good a measure in nonsurgical care, which includes heart failure treatment."

Bhatt reported grants from Amarin, AstraZeneca, Bristol-Myers Squibb, Roche, Eisai, Ethicon, Medtronic, Sanofi Aventis, Pfizer, Forest Laboratories/AstraZeneca, Ischemix, Amgen, Lilly, Chiesi, Ironwood, Abbott, Regeneron, PhaseBio, Idorsia, Synaptic, and The Medicines Company; and serving on the advisory boards of Medscape Cardiology, Regado Biosciences, and Cardax. A complete list of author disclosures is detailed in the original article. Harder has no relevant disclosures.

JAMA Cardiol. Published online November 28, 2018. Abstract

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