America's Best and Worst Hospitals

Quality of Care Gap In Heart Attack, Heart Failure Mortality And Readmission Rates Hospital To Hospital

(CBS/ AP)  Death rates for heart attack and heart failure patients in the U.S. vary significantly from hospital to hospital. This is according to the most comprehensive study of its kind released Thursday by Medicare researchers. Over one million patients at over 4,600 hospitals were surveyed.

Based on data from government statistics, the report found:

The average 30-day death rate for heart attack was 16.6 percent and the average rate of heart attack readmission was 19.9 percent.

The average 30-day death rate for heart failure was 11.1 percent and 24.4 percent for readmission.

Compare Hospitals Here

WebMD: Tips for Choosing a Hospital

Top 3 Hospitals with Lowest Heart Attack Death Rates

Heart Hospital Of Austin,(TX) -- 10.9%
New York-Presbyterian (NY )-- 11.1%
NYU hospital Center (NY) -- 11.1%


CBS News correspondent Nancy Cordes reports that the care can very widely. At the Heart Hospital of Austin in Texas, only 10.9 percent of patients died from their heart attacks compared to 24.9 percent at Southwest Mississippi Regional in McComb.

"This suggests that patients' outcomes are dependent, at least in part, on the hospital that provides their care," Krumholz said in an American Heart Association press release.

"Not only do one out of 5 patients come right back into the hospital but most have never seen a doctor from the time of release to the time they come back. That's not good medical care," said Kathleen Sebelius, Secretary, Department of Health and Human Services.

The government put all the data online, so patients can see how their hospital stacks up on everything from nursing care to blood clot treatments-and hospitals can see how they measure up to their competitors.

Patients should also consider doctor recommendations, distance and insurance coverage when choosing a hospital.

CBS News medical correspondent Dr. Jennifer Ashton said, "all hospitals might not be equally good or bad at everything. So if you have a choice, you might want to go to one hospital for a hip replacement but choose another for your breast biopsy."

Dr. Ashton said the ratings are a big part of the equation. "But you want to find a good doctor you trust who works with a great nursing staff who can give you personalized attention that might be at a big hospital, that also might be at a smaller community hospital."


© MMIX, CBS Interactive Inc. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report.

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by Sloughfoot July 9, 2009 10:59 PM EDT

Two of the low scoring hospitals are from the lower economic areas of this Country. Often lower economic areas also suffer from reduced education, medication availability, transportation issues for follow up checks, etc. As many have stated, the article really lacks sufficient data to be informative.

Reply to this comment

by payasyougo July 9, 2009 10:46 PM EDT

"America's Best and Worst Hospitals"
---
So which one does the folks in Congress go to?

Reply to this comment

by erasmus111 July 9, 2009 10:30 PM EDT

"Not only do one out of 5 patients come right back into the hospital but most have never seen a doctor from the time of release to the time they come back. That's not good medical care,"


It most certainly isn't. When you enter a hospital here, in British Columbia, before you leave, you are given appointments for follow-ups with your specialist and doctor. The hospital will even call you after a few days to see how you are doing.

Reply to this comment

by stn_sage July 9, 2009 10:26 PM EDT

I wouldn't draw any specific conclusions based on this article; other than, prudence and common sense dictates that a person might want to find out where their local hospital(s) rate, just to know, and preferably BEFORE you need to go in!!

Reply to this comment

by riho08 July 9, 2009 10:23 PM EDT

Isn't this fun? Lambasting hospitals and doctors for failing to do the obvious? the "right" thing? For those who have not read the report, a closer look at the people who are having the heart attacks and returning to the hospital, their race/ethnicity and more important, their perceptions of risk is illuminating. The recidivists, those who come back, go home in a state of denial, and vigorously refuse any helping hand from relatives or people who come out and make home visits. Medicine taking, doctors appointments, dietary instructions all fall on a deaf ear. There are cultural reasons for some of these death defying behaviors and medical establishment distrust, these belief systems need to be addressed on a community basis as well as individually. If you want to know why the discrepancies, look at the cliental, and it is as plain as day.

Reply to this comment

by txlakeside July 9, 2009 10:11 PM EDT

Some idiots just can not read an article and follow the links. The idea of a synopsis or overview of a reasearch article is beyond some dumb as dirt readers! Stop blaming the messenger and read the entire message .... dumb as dirt! Others infer that only the fat and obese have heart attacks. My slender, fit 50 year old friend who just went through bypass surgury would argue with that! Some folks just like to complain and moan about any news outlet story provided. I suggest you stop reading the ones you think are worthless and then just post crybaby complaints among your peers on a web site your create ... opps so sorry, you are too big of a crybaby to learn html, Wordpress or other CMS software. It is a free story, you did not pay for it, stop whining! And for the dumb as dirt that brought abortion into the comments .... YOU ARE JUST DUMB AS DIRT!

Reply to this comment

by erasmus111 July 9, 2009 10:21 PM EDT

"Others infer that only the fat and obese have heart attacks. My slender, fit 50 year old friend who just went through bypass surgury would argue with that!"


Yes, that's true. There are many people that have heart problems and heart attacks and are not fat. My mom and my brother have had heart attacks, and neither one of them are over weight.

by healthcarenotdzscare July 9, 2009 11:23 PM EDT

"Others infer that only the fat and obese have heart attacks. My slender, fit 50 year old friend who just went through bypass surgury would argue with that!" I am sorry for your friend and having heart surgery as a fit 50 year old. She did her part to prevent heart disease and genetics or just bad luck counteracted that.
My point was that of all those who have heart attacks (acute myocardial infarctions) the overwhelming majority are either some, a few or many of the following: overweight by a lot, eat many fat rich foods like McDonalds sells, smoke, don't exercise regularly other than the remote control/TIVO, or have high blood pressure and don't take their meds regularly. There are a few very unlucky ones (less than 5% of society) like your friend, that got bad genes and developed heart disease anyway - but they are so very, very few. We must as a society, in general, empower the patient to change their lifestyles to change their mortality and morbidity.
I once heard a statement (can't place the source any more so any help is appreciated) - "Ancient man had to try really hard to be sure he ate, modern man has to try really hard not to."
YMMV

by erasmus111 July 9, 2009 9:34 PM EDT

I watched a program where a doctor was saying that you had to shop around for where you get your meds, because the prices could very GREATLY. He said the same was true for hospitals. And not only money wise, but for care too. They quoted a price of approximately $15,599 for an appendectomy and $15,995 for a broken leg, at one hosptital. (The leg is more that the appendectomy!!) And at another hospital the broken leg cost 9,000. That is outragious that there would be such a difference in price. And they were saying that there was a big difference in the care you got from one hospital to the other. THAT IS SCARY!

And the fact that you can pay $75 for a particular anitbiotic at one pharmacy and at another it's only $10, is absolutely ridiculous!

Reply to this comment

by erasmus111 July 9, 2009 10:02 PM EDT

AND on the show was the women that had the appendectomy and her husband was the one that had the broken leg. The husband waited 2 days with his broken leg before going to the hospital because of the cost. PITIFUL!

And the end of the show the doctor asked the couple if they felt any better now that they knew how things worked. The couple said that they did, but you could tell by the expression on their faces that they didn't. HELLO!? Who the hell in their right mind would feel better to find out that, "YES", they were indeed being ripped off and taken advantage of. Geez.

by erasmus111 July 9, 2009 9:24 PM EDT

by kristianinal July 9, 2009 9:32 AM PDT
My wife is an Emergency Dr. I can tell you from what I have heard from her...the hospital you are in determines whether you live or die in many cases.


Boy, am I glad I don't live in the U.S.

Reply to this comment

by casins July 9, 2009 8:02 PM EDT

this i the medias way of helping obama get his government health plan thru! we are very stupid people not to see this.

stab

Reply to this comment

by nsabucco July 9, 2009 6:46 PM EDT

As a cardiac nurse, the vast majority of readmissions for CHF are because the patient disregards the teaching we provide; i.e. not taking meds as prescribed, not limiting sodium in diet, etc. All healthcare provides can do is educae; it is up to the patient to decide what to do with the information. This report was portrayed as CHF readmissions being the fault of the patients' care. Just another biased report I have come to expect from the news media. Try to remember your rules from intro to journalism.

Reply to this comment

by gravyboat4000 July 9, 2009 7:53 PM EDT

What they need is an intro to healthcare. I've worked in hospitals all my life, the media NEVER gets the story right.

Nothin but a bunch of half truths and filler, to excite the reader/viewer.

by whymayiask July 9, 2009 3:17 PM EDT

They need a correction in their wording then.

Reply to this comment

by whymayiask July 9, 2009 2:18 PM EDT

"The President and Congress have both identified the reduction of readmissions as a target area for health reform," said HHS Secretary Kathleen Sebelius. "When we reduce readmissions, we improve the quality of care patients receive and cut health care costs."

So if I am reading that statement correctly "have one heart attack: we will treat you, have a second: just go die somewhere, that will make OUR numbers look better"

Reply to this comment

by antoniof123 July 9, 2009 2:44 PM EDT

No you are not reading this correctly. What they are saying is DO IT RIGHT THE FIRST TIME.

I mean really do you honestly belive what you wrote please think stop trying to make this political it is a stat that is also a fact.

by rbmartiniv July 9, 2009 1:50 PM EDT

The hosptial comparisons can be found at http://www.hospitalcompare.hhs.gov/Hospital/Search/Welcome.asp

Reply to this comment

by antoniof123 July 9, 2009 2:52 PM EDT

This is really a great site thank you very much.

by useenthat July 15, 2009 2:17 PM EDT

Thanks rbmartiniv,

There is also some nice video that go behind the cover of 2009?s America?s Best Hospitals issue to see which hospitals topped the list, and learn the questions you should be asking at your local hospital. Found at http://www.healthination.com/landing/best-hospitals/landing.html

by John_Merritt July 9, 2009 1:15 PM EDT

All excellent points for sure. Having worked in the cardiac field for quite a few years there are so many variables not mentioned here but I am sure are in the AHA study. As the good doctor's husband stated where you are located from a 'good' hospital (versus large) is very important indeed.

I am not a physician so I cannot tell you to take an aspirin, but ASA and O2 are given immediately for most patients by the ambulance or ER crew. If there is a hospital within the vicinity with a full-fledged well-established heart program, be insistent you be taken there.

Many hosptials do not have invasive Cardiac labs where they do angioplasties and put stents in, and so are unlikely to have a heart surgery program. In those cases thrombolytics (clot busters) are used hopefully. You would be surprised at the many hospitals with either invasive programs and still do not use thrombolytics (or at least did not when I quit.)

When I left a thrombolytic company, we were trying to get these clot busters on the ambulances so they could be administered IV in route to the ER. TIME = MUSCLE. The longer a person waits for anything to happen in their case, the muscle slowly dies and necroses (death of the myocardium -muscle) sets in fairly quickly.

People that ignore the symptoms of a heart attack and do nothing are far more likely to suffer a repeat episode in the future, but with a higher risk of death. Rule of thumb: If you feel like you are having one, DO NOT ignore the symptoms. Get to a hospital immediately. Especially if your risk indicators (healthstyle, genetics, pre-existing conditions) exist.

If they (governement)wants to do something positive in the way medical care is standardized across the board, they need to ensure that systems are in place for 'best results' to occur for all patients. Too many rural areas are lacking in the requisites to create 'compatible with life' episodes. That is not fair, nor is it right.

A great quality health system (hospitals, clinics, physicians and staff) is important for the few as well as the many. Anyway, thanks for the great posts huys. Good day.

Reply to this comment

by Mordue61 July 9, 2009 12:30 PM EDT

Actually they are just quoting the AHA press release.. and even the press release states that 'it is providing just highlights of a very robust amount of information'

So you have to go thru the actual 'robust' report to get details...

Reply to this comment

by martin9p2 July 9, 2009 11:46 AM EDT

justsane-2009 is correct. CBS News, please try again.

Reply to this comment

by martin9p2 July 9, 2009 11:44 AM EDT

"This suggests that patients' outcomes are dependent, at least in part, on the hospital that provides their care," Krumholz said. The article does NOT mention socioeconomic factors, such as patients' ability to take care of themselves after discharge, and other factors. To think that all outcomes should be perfectly equal across the board is to deny that patients play a role in their own care, and it is to deny there are "good hospitals" and "good doctors" among the average ones.

Reply to this comment

by DeaconVMason July 11, 2009 3:00 PM EDT

There are other comments below that talk about post-hospital care. Ever since the increase of day surgeries and short hospital stays, it seems that medical professionals are in denial about post-hospital nursing care. If they require having someone drive the patient home from a day procedure, why don't they require the patient to make arrangements to have a friend or relative stay with them during the first 48 hours after being released? This could apply to hospital stays for serious conditions, like heart attacks. A lot of people honestly believe that if the doctor is releasing them from the hosptial or if the procedure was a day surgery or out-patient event, they really don;t need help. Let's be realistic about the situation. It's not just the hosptial care, it's also about the reality that patients often need general nursing care afterwards. If there is no friend or relative, perhaps the insurance company could afford to spend a couple hundred dollars for a para-professional to spend a couple of days with the patient. That would be far less expensive than a day or two more in the hospital.

by justsane-2009 July 9, 2009 11:30 AM EDT

there is little to no information here. where are these hospitals? are they urban? rural? private or public? in regions where there are high levels of obesity? small hospitals or large? it strikes me that there are so many unanswered questions in this article as to render it useless. try again.

Reply to this comment

by nofoolling July 9, 2009 4:21 PM EDT

You're right, whoever wrote this article went to great length to not give us any pertinent information such as which hospitals got low scores, which areas of the country have problems etc.

Sounds almost like he/she or their bosses are protecting the poorer rated hospitals. I wonder why?

It would have been helpful to at least tell us which hospitals we have the best chance of living through treatment at.

Another disservice done.

by vielmann July 9, 2009 6:09 PM EDT

In other words, how can we blame the patients and not the failing US healthcare system.

by macalongtimeago July 9, 2009 6:58 PM EDT

I am a nurse and you are right. There is NO information here. Utterly useless.

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[Sloughfoot]

Two of the low scoring hospitals are from the lower economic areas of this Country. Often lower economic areas also suffer from reduced education, medication availability, transportation issues for follow up checks, etc. As many have stated, the article really lacks sufficient data to be informative.

[payasyougo]

"America's Best and Worst Hospitals"
---
So which one does the folks in Congress go to?

[erasmus111]

"Not only do one out of 5 patients come right back into the hospital but most have never seen a doctor from the time of release to the time they come back. That's not good medical care,"


It most certainly isn't. When you enter a hospital here, in British Columbia, before you leave, you are given appointments for follow-ups with your specialist and doctor. The hospital will even call you after a few days to see how you are doing.

[stn_sage]

I wouldn't draw any specific conclusions based on this article; other than, prudence and common sense dictates that a person might want to find out where their local hospital(s) rate, just to know, and preferably BEFORE you need to go in!!

[riho08]

Isn't this fun? Lambasting hospitals and doctors for failing to do the obvious? the "right" thing? For those who have not read the report, a closer look at the people who are having the heart attacks and returning to the hospital, their race/ethnicity and more important, their perceptions of risk is illuminating. The recidivists, those who come back, go home in a state of denial, and vigorously refuse any helping hand from relatives or people who come out and make home visits. Medicine taking, doctors appointments, dietary instructions all fall on a deaf ear. There are cultural reasons for some of these death defying behaviors and medical establishment distrust, these belief systems need to be addressed on a community basis as well as individually. If you want to know why the discrepancies, look at the cliental, and it is as plain as day.

[txlakeside]

Some idiots just can not read an article and follow the links. The idea of a synopsis or overview of a reasearch article is beyond some dumb as dirt readers! Stop blaming the messenger and read the entire message .... dumb as dirt! Others infer that only the fat and obese have heart attacks. My slender, fit 50 year old friend who just went through bypass surgury would argue with that! Some folks just like to complain and moan about any news outlet story provided. I suggest you stop reading the ones you think are worthless and then just post crybaby complaints among your peers on a web site your create ... opps so sorry, you are too big of a crybaby to learn html, Wordpress or other CMS software. It is a free story, you did not pay for it, stop whining! And for the dumb as dirt that brought abortion into the comments .... YOU ARE JUST DUMB AS DIRT!

[erasmus111]

"Others infer that only the fat and obese have heart attacks. My slender, fit 50 year old friend who just went through bypass surgury would argue with that!"


Yes, that's true. There are many people that have heart problems and heart attacks and are not fat. My mom and my brother have had heart attacks, and neither one of them are over weight.

[healthcarenotdzscare]

"Others infer that only the fat and obese have heart attacks. My slender, fit 50 year old friend who just went through bypass surgury would argue with that!" I am sorry for your friend and having heart surgery as a fit 50 year old. She did her part to prevent heart disease and genetics or just bad luck counteracted that.
My point was that of all those who have heart attacks (acute myocardial infarctions) the overwhelming majority are either some, a few or many of the following: overweight by a lot, eat many fat rich foods like McDonalds sells, smoke, don't exercise regularly other than the remote control/TIVO, or have high blood pressure and don't take their meds regularly. There are a few very unlucky ones (less than 5% of society) like your friend, that got bad genes and developed heart disease anyway - but they are so very, very few. We must as a society, in general, empower the patient to change their lifestyles to change their mortality and morbidity.
I once heard a statement (can't place the source any more so any help is appreciated) - "Ancient man had to try really hard to be sure he ate, modern man has to try really hard not to."
YMMV

[erasmus111]

I watched a program where a doctor was saying that you had to shop around for where you get your meds, because the prices could very GREATLY. He said the same was true for hospitals. And not only money wise, but for care too. They quoted a price of approximately $15,599 for an appendectomy and $15,995 for a broken leg, at one hosptital. (The leg is more that the appendectomy!!) And at another hospital the broken leg cost 9,000. That is outragious that there would be such a difference in price. And they were saying that there was a big difference in the care you got from one hospital to the other. THAT IS SCARY!

And the fact that you can pay $75 for a particular anitbiotic at one pharmacy and at another it's only $10, is absolutely ridiculous!

[erasmus111]

AND on the show was the women that had the appendectomy and her husband was the one that had the broken leg. The husband waited 2 days with his broken leg before going to the hospital because of the cost. PITIFUL!

And the end of the show the doctor asked the couple if they felt any better now that they knew how things worked. The couple said that they did, but you could tell by the expression on their faces that they didn't. HELLO!? Who the hell in their right mind would feel better to find out that, "YES", they were indeed being ripped off and taken advantage of. Geez.

[erasmus111]

by kristianinal July 9, 2009 9:32 AM PDT
My wife is an Emergency Dr. I can tell you from what I have heard from her...the hospital you are in determines whether you live or die in many cases.


Boy, am I glad I don't live in the U.S.

[casins]

this i the medias way of helping obama get his government health plan thru! we are very stupid people not to see this.

stab

[nsabucco]

As a cardiac nurse, the vast majority of readmissions for CHF are because the patient disregards the teaching we provide; i.e. not taking meds as prescribed, not limiting sodium in diet, etc. All healthcare provides can do is educae; it is up to the patient to decide what to do with the information. This report was portrayed as CHF readmissions being the fault of the patients' care. Just another biased report I have come to expect from the news media. Try to remember your rules from intro to journalism.

[gravyboat4000]

What they need is an intro to healthcare. I've worked in hospitals all my life, the media NEVER gets the story right.

Nothin but a bunch of half truths and filler, to excite the reader/viewer.

[whymayiask]

They need a correction in their wording then.

[whymayiask]

"The President and Congress have both identified the reduction of readmissions as a target area for health reform," said HHS Secretary Kathleen Sebelius. "When we reduce readmissions, we improve the quality of care patients receive and cut health care costs."

So if I am reading that statement correctly "have one heart attack: we will treat you, have a second: just go die somewhere, that will make OUR numbers look better"

[antoniof123]

No you are not reading this correctly. What they are saying is DO IT RIGHT THE FIRST TIME.

I mean really do you honestly belive what you wrote please think stop trying to make this political it is a stat that is also a fact.

[rbmartiniv]

The hosptial comparisons can be found at http://www.hospitalcompare.hhs.gov/Hospital/Search/Welcome.asp

[antoniof123]

This is really a great site thank you very much.

[useenthat]

Thanks rbmartiniv,

There is also some nice video that go behind the cover of 2009?s America?s Best Hospitals issue to see which hospitals topped the list, and learn the questions you should be asking at your local hospital. Found at http://www.healthination.com/landing/best-hospitals/landing.html

[John_Merritt]

All excellent points for sure. Having worked in the cardiac field for quite a few years there are so many variables not mentioned here but I am sure are in the AHA study. As the good doctor's husband stated where you are located from a 'good' hospital (versus large) is very important indeed.

I am not a physician so I cannot tell you to take an aspirin, but ASA and O2 are given immediately for most patients by the ambulance or ER crew. If there is a hospital within the vicinity with a full-fledged well-established heart program, be insistent you be taken there.

Many hosptials do not have invasive Cardiac labs where they do angioplasties and put stents in, and so are unlikely to have a heart surgery program. In those cases thrombolytics (clot busters) are used hopefully. You would be surprised at the many hospitals with either invasive programs and still do not use thrombolytics (or at least did not when I quit.)

When I left a thrombolytic company, we were trying to get these clot busters on the ambulances so they could be administered IV in route to the ER. TIME = MUSCLE. The longer a person waits for anything to happen in their case, the muscle slowly dies and necroses (death of the myocardium -muscle) sets in fairly quickly.

People that ignore the symptoms of a heart attack and do nothing are far more likely to suffer a repeat episode in the future, but with a higher risk of death. Rule of thumb: If you feel like you are having one, DO NOT ignore the symptoms. Get to a hospital immediately. Especially if your risk indicators (healthstyle, genetics, pre-existing conditions) exist.

If they (governement)wants to do something positive in the way medical care is standardized across the board, they need to ensure that systems are in place for 'best results' to occur for all patients. Too many rural areas are lacking in the requisites to create 'compatible with life' episodes. That is not fair, nor is it right.

A great quality health system (hospitals, clinics, physicians and staff) is important for the few as well as the many. Anyway, thanks for the great posts huys. Good day.

[Mordue61]

Actually they are just quoting the AHA press release.. and even the press release states that 'it is providing just highlights of a very robust amount of information'

So you have to go thru the actual 'robust' report to get details...

[martin9p2]

justsane-2009 is correct. CBS News, please try again.

[martin9p2]

"This suggests that patients' outcomes are dependent, at least in part, on the hospital that provides their care," Krumholz said. The article does NOT mention socioeconomic factors, such as patients' ability to take care of themselves after discharge, and other factors. To think that all outcomes should be perfectly equal across the board is to deny that patients play a role in their own care, and it is to deny there are "good hospitals" and "good doctors" among the average ones.

[DeaconVMason]

There are other comments below that talk about post-hospital care. Ever since the increase of day surgeries and short hospital stays, it seems that medical professionals are in denial about post-hospital nursing care. If they require having someone drive the patient home from a day procedure, why don't they require the patient to make arrangements to have a friend or relative stay with them during the first 48 hours after being released? This could apply to hospital stays for serious conditions, like heart attacks. A lot of people honestly believe that if the doctor is releasing them from the hosptial or if the procedure was a day surgery or out-patient event, they really don;t need help. Let's be realistic about the situation. It's not just the hosptial care, it's also about the reality that patients often need general nursing care afterwards. If there is no friend or relative, perhaps the insurance company could afford to spend a couple hundred dollars for a para-professional to spend a couple of days with the patient. That would be far less expensive than a day or two more in the hospital.

[justsane-2009]

there is little to no information here. where are these hospitals? are they urban? rural? private or public? in regions where there are high levels of obesity? small hospitals or large? it strikes me that there are so many unanswered questions in this article as to render it useless. try again.

[nofoolling]

You're right, whoever wrote this article went to great length to not give us any pertinent information such as which hospitals got low scores, which areas of the country have problems etc.

Sounds almost like he/she or their bosses are protecting the poorer rated hospitals. I wonder why?

It would have been helpful to at least tell us which hospitals we have the best chance of living through treatment at.

Another disservice done.

[vielmann]

In other words, how can we blame the patients and not the failing US healthcare system.

[macalongtimeago]

I am a nurse and you are right. There is NO information here. Utterly useless.