Get With The Guidelines SM Saving Lives…One Hospital, One Patient at a Time September 28, 2006 Present by: Mary Paulsen, MSN RN Quality Improvement Director American Heart Association/American Stroke Association

Today’s Agenda Introduction to the American Heart Association The Critical Issue of Heart Disease and Stroke Challenges within Patient Care Today Get With The Guidelines SM Creates a Culture of Quality Benefit of Get With The Guidelines Collaborative opportunities underway with DOH/CMS/GWTG 2

Our Story 3 Our organization was founded in 1924 by six cardiologists who came together to share research and promote further study of heart disease. Since then, we ’ ve grown to be the largest voluntary organization fighting heart disease/stroke in the U.S. with 22.5 million donors and volunteers who help direct more than $500 million each year to our research for effective prevention and treatment of CVD and stroke. Together, we have made life longer and stronger. Our work has funded the work of eight Nobel Laureates and spurred revolutionary innovations such as bypass surgery, CPR and the pace- maker …

Together AHA and ASA 4 Reduce disability and death from heart disease and stroke - Fighting #1 and #3 killers of adults across all demographics and economic backgrounds - Strategic driving force to provide credible, effective prevention/treatment information Decrease heart disease, stroke and risk by 25% by Strategy: To improve the quality of CVD outcomes for patients Largest voluntary organization fighting heart disease/stroke in the U.S affiliates and 2200 divisions across the country - Professional membership of 13 scientific councils, three interdisciplinary working groups - Trusted source for hospitals and healthcare providers across the country Invest $400 million dollars in research, education and awareness annually - Latest guidelines, journals, conferences, seminars and educational information provided OrganizationalMission GrassrootsReach GroundbreakingResearch ImpactGoal

Heart Disease and Stroke Today Cardiovascular diseases (CVD) accounted for 38% of deaths in the U.S. in % of these deaths from CVD occurred prematurely Heart attack survivors have times greater risk of illness/death post-event In 2005, the estimated direct and indirect cost of CVD is $393.5 billion More than 70 million Americans have one or more types of cardiovascular disease … AHA and ASA, along with our strategic alliance partners and donors, work every day to lessen the human and financial toll of these chronic diseases. 5 *American Heart Association, Statistical Update, 2005

More than half of all heart disease and stroke patients do not receive consistent preventive instructions upon discharge from the hospital … Heart and Stroke Patient Treatment 66% of heart failure patients were discharged without four proven prevention therapies 68% of patients who smoked were not advised to quit 33% of “ideal” candidates were not treated with ACE Inhibitors 6 *The Wall Street Journal, November 9, 2003, Physicians’ Weekly, June 21, 2004, ADHERE Study

Challenging Reality  Discharge protocols  Written discharge instructions  Risk modification counseling  Appropriate prescriptions Proven, evidence-based preventive guidelines are known and available, and should be part of every hospital’s routine… …but sadly, this is not always the case. “We now have a situation where medicine is by memory. Busy clinicians try to recall for each complex patient the appropriate evidence-based therapies, all during the chaos of the day. If they don't remember all of this… there are repetitive oversights.” Gregg Fonarow, MD, FACC, FACP UCLA Division of Cardiology 7

Gaps in Overall Quality of Care Tens of thousands of patients die each year due to preventable healthcare errors More people die annually from medical errors than from AIDS or breast cancer It takes an average of 17 years for new knowledge to be incorporated into practice 8 *Institute of Medicine, Shaping the Future for Health, 2001 and To Err is Human, 1999 “Healthcare harms patients too frequently and routinely fails to deliver its potential benefits. Between the healthcare that we now have and the healthcare that we could have lies not just a gap, but a chasm.”

Devastating Results 40% of heart disease or stroke patients will have a repeat event 38% of women and 25% of men will die within a year of a heart attack 25% of men and 22% of women will die within a year of a stroke 46% of women and 22% of men will be disabled 9 *Physicians’ Weekly, American Heart Association Statistical Update “Patients go to hospitals, and half the time are being discharged without the complete group of therapies that have been absolutely proven to prolong their life, and there is no reason other than the medical system just isn’t working that well.”

Opportunity for Hope 10 Experts suggest that mortality rates after acute coronary syndromes could be reduced by up to 80% just by properly instituting the knowledge and guidelines already proven. “There’s little disagreement on the value of making up these treatment gaps. We need to break the gaps and recognize the tremendous barrier in outpatient care to effectively implement and retain important therapies…to save more lives.” Gregg Fonarow, MD *Circulation, February 17, 2004, Physicians’ Weekly, June 21, 2004

Introducing the Solution “Get With The Guidelines SM is a model for the nation in addressing a dire health-care issue. The program helps patients, working with caregivers, learn how to take action to save their own lives.” - Tommy Thompson, Secretary of HHS 11 The American Heart Association has developed an unprecedented method to close this treatment gap Derived directly from evidence-based guidelines, the program provides tools and resources designed to help hospitals dramatically reduce patients ’ risk of recurrent cardiovascular events

Proven Results Scandinavian Simvastatin Survival Study (4S) Decrease in recurrent events/mortality: 34% risk reduction for recurrent events 42% risk reduction in CVD mortality Brown University Study Improvement in preventive treatments: 89% given aspirin, up from 75% 85% given Beta-Blockers, up from 62% UCLA CHAMP Study Decrease in recurrent events/mortality: Risk down to 6.4% from 14.8% Improvement in preventive treatments: use of Statins up to 86% from 6% use of Beta-Blockers up to 61% from 12% use of ACE Inhibitors up to 56% from 4% 12 New England Pilot Program Improvement in preventative treatments: 86% smoking cessation, up from 48% 88% lipid treatment, up from 54% 74% rehabilitation referral, up from 34%

1. Incorporate latest proven research and knowledge of leading industry groups 2. Utilize “teachable moment” prior to patient discharge 3. Take a multi-disciplinary team approach 4. Develop and empower leaders to change culture of quality within hospitals 5. Provide ability for measurement via Web-based clinical decision support tool 6. Provide hospitals with consistent patient-discharge protocols 7. Offer customized patient materials 8. Encourage provider-to-provider communications 9. Recognize 85% compliant hospitals as performance leaders 10. Improve patient quality of life and reduce risk Program Strategy 13

How It Works The process-improvement and overall culture of change that is prompted by Get With The Guidelines SM automatically drives increased patient safety 14

Proven Risk Reduction Therapies: - Lipid lowering therapy - ACE Inhibitor/ARB use - Beta-Blocker use -Aspirin or other Antithrombotic medication -t-PA Pre-discharge Counseling: - Smoking cessation - Weight and exercise management - Insulin control - Alcohol and drug abuse management Post-treatment Referrals: - Cardiac Rehabilitation Guidelines for Treatment and Prevention Adherence to these treatment guidelines reduces risk of death and/or recurrent events by up to 40% in patients 15 *American Heart Association

AHA Support and Resources 16

Easy Implementation Hospitals Reap the Benefits Improved Outcomes Improved Care “We did calculations based upon how well we were performing before we initiated this program and realized that we were going to be able to save lives or prevent second heart attacks.” 17 “With systems in place to get things done, I don’t have to change one physician’s behavior at a time, but I give them a system and framework in which to practice that’s quite easy to implement.” “As a cardiologist…I’m convinced it is improving the care of my patients. As an AHA volunteer, I’m equally convinced it’s critical to improving the quality of care for patients nationwide.” - Karol Watson, MD, UCLA Medical Center - Robert O. Bonow, MD, AHA President - Gray Ellrodt, MD, Berkshire Medical Center

Hospitals Reap the Benefits, cont’d Cost Savings Increased Communications “We began to realize we were actually reducing the amount of time documenting--by imbedding the guidelines into order sets and discharge sheets, it decreased the amount of time to write orders and on follow-up phone calls regarding clarification of contraindications.” 18 “What started as a program to help patients, helped our staff too. Our collective brainstorming sessions gave us an opportunity to be part of a creative, team experience toward a positive goal.” - Gregg Fonarow, MD, UCLA Cardiomyopathy Center - Mary Jensen, RN, Presbyterian/St. Luke’s Hospital

Peace of Mind for Patients and their Loved Ones Improved Communication With Healthcare Providers Increased coordination between hospital and referring physicians Improved Communication With Healthcare Providers Increased coordination between hospital and referring physicians Higher Quality of Care Consistent, comprehensive, proven treatment methods Higher Quality of Care Consistent, comprehensive, proven treatment methods Customized Education Information Short and long-term prevention strategies are based on patient’s specific risk profile Customized Education Information Short and long-term prevention strategies are based on patient’s specific risk profile Up-to-date Prevention Strategies New techniques are made available through easy-to-understand tools Up-to-date Prevention Strategies New techniques are made available through easy-to-understand tools Decreased risk of death or recurrent related health problems “Patients have a 10-to-15 fold higher likelihood of adhering to recommended prevention therapy when it is started in the hospital.” 19 *Physicians’ Weekly, June 21, 2004

Proof Points 20 Hospitals have shown “across the board improvement” in quality of care provided to patients through the Get With The Guidelines SM initiative. - Kenneth A. LaBresh, Brown University > 1000 hospitals currently participate in the program, improving the care of 660,000 patients Since its inception in 2001, Get With The Guidelines SM has grown to three modules Several studies among Get With The Guidelines SM hospitals across the country have shown: –Adherence to all ten measures were enhanced in year one for GWTG-CAD –Racial and ethnic treatment disparities were narrowed or eliminated in 83% of measures –Gender-related treatment gaps were narrowed or eliminated in four of five measures –An average of 20% improvement in eight measures for GWTG-Stroke in one year *The Wall Street Journal, November 9, 2003, Abstracts from AHA’s Scientific Sessions, 2004, Abstracts from ASA’s International Stroke Conference 2005

Collaborative Opportunities Underway New Mexico Department of Health funding ~funding for 5 GWTG Stroke modules placed by July 06 Funding from State Legislature Colorado State Stroke Registry ~ funding for 26 hospitals to participate in GWTG Stroke by July 07 Amendment 35 Funding Colorado Foundation for Medical Care “Get With the Guidelines” Grant – funding for 34 modules (CAD and/or HF) to be placed by July 07 Amendment 35 Funding

Our Future Plans  Position AHA/ASA guidelines as the preferred standard of care  Increase implementation to 1,800 hospitals across the country by the end of 2008  Obtain 85% compliance by hospitals on the Get With The Guidelines SM indicators  Leverage research to further enhance quality of care by gathering current best practices  Champion the issue of health information technology and integrate hospital electronic systems  Explore potential to create new custom modules for more deadly, debilitating disease states 28 With your generous and much needed support in the coming years, we will continue to work toward attaining our lofty objectives:

Appendix 29

“In-Hospital Initiation of Guideline-Recommended Therapies and Patient Education Improves Treatment Rates, Long-Term Adherence, and Clinical Outcomes” Physician’s Weekly, June 21, 2004“In-Hospital Initiation of Guideline-Recommended Therapies and Patient Education Improves Treatment Rates, Long-Term Adherence, and Clinical Outcomes” Physician’s Weekly, June 21, 2004 “Heart Patients More Likely to Live When Recommended Medicines Used in Combination” Circulation: Journal of the American Heart Association, February 17, 2004“Heart Patients More Likely to Live When Recommended Medicines Used in Combination” Circulation: Journal of the American Heart Association, February 17, 2004 “More Kentucky Hospitals Following Heart Disease Prevention Program Guidelines” Kentucky Department of Health, January 2004“More Kentucky Hospitals Following Heart Disease Prevention Program Guidelines” Kentucky Department of Health, January 2004 December 2003Media Coverage Summary of Get With The Guidelines SMDecember 2003 Media Coverage Summary of Get With The Guidelines SM November 2003 Media Coverage Summary of Get With The Guidelines SMNovember 2003 Media Coverage Summary of Get With The Guidelines SM “Heart Studies Cite Treatment Gaps” Wall Street Journal, November 9, 2003“Heart Studies Cite Treatment Gaps” Wall Street Journal, November 9, 2003 Cardiovascular Watch Newsletter, May 21, 2004Cardiovascular Watch Newsletter, May 21, Studies and Reports Articles “Crossing the Quality Chasm: A New Health System for the 21st Century” Institute of Medicine, March 2001“Crossing the Quality Chasm: A New Health System for the 21st Century” Institute of Medicine, March 2001 “To Err is Human” Institute of Medicine, 1999“To Err is Human” Institute of Medicine, 1999 “Cardiac Program Unites Staff at Denver Hospital,” Sidebar – Presbyterian/St. Luke’s Success, Mary Jensen, RN, Kind Hearts and Helping Hands“Cardiac Program Unites Staff at Denver Hospital,” Sidebar – Presbyterian/St. Luke’s Success, Mary Jensen, RN, Kind Hearts and Helping Hands Research Review

27 Press Releases “American Heart Association's Hospital-based Quality Improvement Program Receives Award From Health and Human Service Secretary Tommy Thompson” American Heart Association, December 13, 2004“American Heart Association's Hospital-based Quality Improvement Program Receives Award From Health and Human Service Secretary Tommy Thompson” American Heart Association, December 13, 2004 “Hospitals That Follow Heart Attack Guidelines Have Lower In-Hospital Death Rates” American Heart Association, November 17, 2002“Hospitals That Follow Heart Attack Guidelines Have Lower In-Hospital Death Rates” American Heart Association, November 17, 2002 “Hospitals That Follow Guidelines May Reap Rewards” American Heart Association, October 13, 2002“Hospitals That Follow Guidelines May Reap Rewards” American Heart Association, October 13, 2002 “American Heart Association Encourages Acute Care Hospitals to Get With The Guidelines SM ” American Heart Association, August 2002“American Heart Association Encourages Acute Care Hospitals to Get With The Guidelines SM ” American Heart Association, August 2002 “American Heart Association Healthcare Quality Improvement Program Recognized by U.S. Health and Human Services” American Heart Association, February 28, 2002“American Heart Association Healthcare Quality Improvement Program Recognized by U.S. Health and Human Services” American Heart Association, February 28, 2002 “Heart Treatment Gap Closes With Standardized Care” American Heart Association, October 2001“Heart Treatment Gap Closes With Standardized Care” American Heart Association, October 2001 Research Review