1. Get With The Guidelines SM Saving Lives…One Hospital, One Patient at a Time presented to The Michigan Center for Rural Health’s Quality Network 2-22-2008 by Kimberly Sutter, MSN, RN, CNAA

2. 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 Why Get With The Guidelines SM ? How To Get Started Resources 2

3. 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 …

4. 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 2010 - Strategy: To improve the quality of CVD outcomes for patients Largest voluntary organization fighting heart disease/stroke in the U.S. - 12 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

5. A major Milestone was recently met!! American Heart Association Reaches 2010 Goal of Reducing Heart Disease-- Ahead of Schedule! New mortality data from the Centers for Disease Control and Prevention (CDC) shows that, since 1999, coronary heart disease and stroke age- adjusted death rates are down by 25.8 percent and 24.4 percent, respectively.

6. Imagine The Impact..Imagine The Difference.. In Our Patient’s Lives, and In Their Families Lives! Let’s Make That Impact..

7. But, despite this milestone…Heart Disease and Stroke are still the 1 st and 3 rd killers in Michigan and in the US. 7 Our Work Isn’t Done..But, Now..We Know What Works!

8. More than half of all heart disease and stroke patients do not receive consistent preventive instructions upon discharge from the hospital … 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 8 *The Wall Street Journal, November 9, 2003, Physicians’ Weekly, June 21, 2004, ADHERE Study

9. 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 9

10. 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 10 *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.”

11. 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 11 *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.”

12. Opportunity for Hope 12 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

13. 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 13 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

14. 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% 14 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%

15. 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 15

16. 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 16

17. 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 17 *American Heart Association

18. AHA Support and Resources 18

19. 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.” 19 “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, 2002-2003 AHA President - Gray Ellrodt, MD, Berkshire Medical Center

20. 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.” 20 “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