Heart attacks are one of the things that Medicare, CMS and the Institute of Medicine have focused on in order to improve survival. They have required more and more documentation of how patients with heart attacks are handled and threaten hospitals with punishment, including loss of accreditation if the paper work and documentation are not done using specific guidelines. What they do not seem to understand is that a lot of the patient's chance of survival depends on the clinical judgement of the ER doctors and nurses, the experience of the cardiologists, the work ethic of all of the medical personnel and how they communicate with each other. Money and threats of sanctions from the all knowing experts who write the guidelines does not save lives. It is the knowledge and expertise of the medical people in the trenches that does this.

I'm confused. If top-notch medical researchers can't figure out what makes one hospital better than another for a particular condition, how am I supposed to "act like a well-informed consumer" and make that decision? That's even assuming that I have the chance; most heart attack sufferers get taken to the nearest hospital, or the only one, or the one reputed to have the best cardiac service, and there isn't time to do thorough online research even if you could. It is insane to tell consumers it's our job to try to figure this stuff out.

take this. it is good to go into a hospital, alive to get treatment. all is fine until you come out dead. it is hush, hush, mostly kept secret. ?????????

Actually, this study only confirms what hospitals all know. That quality does vary and where you go does matter. If you want to know how your hospital stacks up, just go to Healthgrades.com, which uses the outcome data from the Medicare database. That's what all the hospitals are looking at every month. One of the reasons we found that our hospital does so well on treating heart attack patients is that our ER gets them to the cardiac catheterization lab in under 40 minutes. Want to know how they do that? They were one of our earliest adopters of the electronic medical record and get lab results back very quickly, confirming the patients need for a stent. Several studies have shown that your surviving a heart attack is highly correlated to how quickly it is identified and how quickly you can get to the cath lab.

Where you go does matter. And this variation is real. Check out Healthgrades or Hospitalcompare.gov

As long as you have insurance companies determining who gets what care this kind of nonsense will happen. If the researchers would look at the main insurance providers for a hospital, it will become very clear why some are good and some are aweful. Of course, by law, the people doing the study can't get that information. Why, because the insurance companies paid off the politians to make such disclosures against the law.

Having gotten a cardiac artery stent in late May I had some exposure to the cardiac care unit. During a shift change, the incoming nurse discovered that there was no signal from one of the leads on my monitor. She came right in and re-attached it as it had come off. I noticed when it came off and that was hours before that shift change. I am biased as my daughter is a nurse-practioner but the variation in the quality of nursing is considerable. A poor nurse having a bad day is probably more of a danger than a help. Doctors run the entire range too. I was lucky I recognized the angina and got to a good hospital with good staff before the 80% blocked artery choked on a clot and caused a heart attack. The pain was too high in the chest to be my stomach. I was certain of what it was and I knew I had never felt it before. It was 1:00 AM when I felt a slight pain. What made me go to the hospital was that after a half hour a little still remained. It was Monday morning and I was to see my regular Doctor on Tuesday. It would have been just too lame to have waited and then told her that "by the way, I had chest pains yesterday". At 1:30 AM all I wanted to do was go to sleep. As my daughter later pointed out, after giving me hell for driving myself to the hospital, if I had gone to sleep, there is a good chance I would not be alive today. Another thing to wrestle with is diet. It is hard to deny the craving for fatty junk food. If your arterys are narrow it's like Russian Roulette. The advice I got from the hospital dietitian was good but it sure is hard to stay compliant.

In short, all of the staff in all of the applicable departments at the hospital have an effect not only by what they do but how it comes across to the patient. Getting the right message across about what is going on and what the patient is responsible for, may be making the difference between the hospitals. Attitude could very well be the largest factor and would be extremely hard to measure. I have worked at companies where I loved what I was doing but hated the environment, that may also be true at some hospitals. A bad boss can ruin the best job.

My father died from a heart attack and he was at one of the best hospitals in Reno,Nevada. Apparently they put him in a medical induced coma on top of his coma I have mixed views on this but they graduated school for this. As you could only imagine it was a disappointed to hear that he passed after all of these things they attempted to do. So really I guess it comes down to a matter of timing if they get to you a second sooner you have better odds and that's really what it simmers down to.

People are defined by the amount of money they have. Period. Whatever side of town you live on determines whether you should get care from a hospital or police department. Is this a news flash? We are out of the Republican Era where everyone is o.k. because Reagan said let things trickle down to the less advantaged. It didn't work and it doesn't work. The world is not what has been shown on t.v. It is real and it is right outside at your doorstep.

Truthfully, it's not the money. I had the absolute worst care on the face of the earth in a hospital that did its first open heart procedure while I was there. The place was glutted with money. Every room was a private one, they had the "total care beds" (which are, without question, the most uncomfortable beds in the world, a flat rock would have been more comfortable) even though I'm sure you could buy a small Third World country for what they spent on them, and every piece of equipment and supply that you could ask to have literally at your fingertips. They had R.N.s doing all bedside care, which is a horrible waste of skilled nursing personnel....if I had spent all the time and money getting an education that these kids do when I was in nursing school I would have thought anyone who told me to do total care was a complete lunatic and would not have hesitated to say so, as I was walking out the door......and had no more than three patients each.

You have to have nurses who are not tied up changing beds and delivering water and ice and who knows what else and who can pick up on subtle signs of trouble before they evolve into a major event. I well remember one night when I called a doc at 2:00 a.m. fully expecting him to scream obscenities and slam the phone in my ear because I had no concrete reason for calling him about the patient. He asked a couple of questionsnot only about the vital signs and other indicators as well as asking why I had called him. When I hesitated regarding why I had called, he said, "Do you have a feeling I need to be there?"

I finally told him that I did, even though I couldn't explain why. He told me he would be there in ten minutes and was, with no complaints. After the crisis was over....the patient went sour just as he walked in the door....he told me that when nurses "have a feeling" it almost always means they're picking up on something that is so subtle that even vital signs don't reflect it. He said the most critical time to call was when you "had a feeling" with nothing specific to back it up.

Unfortunately, not all docs follow that line of logic, and the patients suffer for it. Additionally, when nurses are tied up with scut work, they tend not to notice their gut feelings because they are too engrossed in how much they still have to get done. Sadly, it's becoming a lost art.

So, find a hospital with good nurses. They're your first line of defense and ultimately may well be your only hope if you are seriously ill. Some of the best nurses I've ever met worked in some of the oldest, rattiest, poorest hospitals, and I can assure you that they're not getting top pay. However, they are there because they cannot even imagine a life where they were not doing exactly what they are doing, regardless of pay scale.

I can say from experience that money matters sometimes more than a patient's well being. For example, a low nurse to patient ratio is proven to reduce deaths but a hospital will push more patients on a nurse than is safe in order to speed less on wages. We need laws to prevent this dangerous practice.

I too am disappointed at this study. It looks more like a witch hunt than research. These kids have no clue what they are doing.