• Quality in heart care

    The UK Gill Heart Institute’s team of physicians and specially trained nurses provides personal care while maintaining the highest clinical standards. 

    As a testament to these standards, in 2014 UK HealthCare was awarded the Get with the Guidelines-Resuscitation Gold Quality Achievement Award by the American Heart Association for using guidelines-based care to improve patient outcomes from in-hospital cardiac arrest. 

    Our goal is to provide every patient with exceptionally compassionate care in the safest and most appropriate manner possible based on the best evidence and the latest technological advances.


  • 1. Quality: overall PCI risk-adjusted mortality, 2014

    This graph shows the in-hospital death rate for patients who had a procedure to open blocked coronary arteries. Here, a lower number is better. It takes into account how sick the patient is. If the patient is older or has some serious health problems, the risk of death is higher. The blue line shows our number. This compares our number to all U.S. hospitals (gray line) reporting to the CathPCI Registry*.

    Overall PCI risk-adjusted mortality

This graph shows the in-hospital death rate for patients who had a procedure to open blocked coronary arteries. Here, a lower number is better.  This compares our number to all U.S. hospitals  reporting to the CathPCI Registry*. The scale ranges from 1.00 to 3.19. The U.S. average is 1.84. The UK average is 1.64.

    View a text summary of this graph »

    Some of the factors that affect a patient’s risk of death include:

    • Age.
    • Diagnosis on admission and whether the patient is having an ongoing heart attack.
    • Presence of cardiogenic shock (inability of the heart function to support body organs).
    • Cardiac arrest or cardiac death that occurs outside of the hospital prior to the procedure.
    • Heart function and ejection fraction before the procedure.
    • The number of diseased blood vessels.
    • Emergency of the procedure.
    • Kidney function.
    • Body mass index.
    • Whether the patient has diabetes, heart failure or chronic lung disease.

    The PCI mortality at UK Gill Heart Institute was lower than the national average despite the fact that we treat the highest-risk patients, more so than most catheterization laboratories around the country. These patients include those with cardiogenic shock or those who had cardiac arrest prior to PCI.

    Cardiogenic shock or cardiac arrest prior to PCI

    Cardiogenic shock or cardiac arrest prior to PCI

The chart on the left shows the proportion of patients presenting with cardiogenic shock. At UK Gill Heart Institute 6.1% of patients had cardiogenic shock compared to 2.4% at all hospitals.

The chart on the right shows the proportion of patients with cardiac arrest before presentation. At UK Gill Heart Institute 5.3% had cardiac arrest compared to 2.3% at all hospitals.

    View a text summary of these graphs » 

    The percentage of cardiogenic shock and cardiac arrest patients treated at the Gill Heart Institute (blue bars) is more than double the average of similar patients treated in other US hospitals (gray bars) reporting to the CathPCI Registry*.

    2. Discharge medicines in 2014

    Discharge medicines

95.3% of UK Gill Heart Institute patients receive the correct prescriptions at discharge, compared to 94.6% of patients in all hospitals.


    View a text summary of this graph » 

    This shows whether we prescribe the right medicines for our patients when they leave the hospital. A higher number is better. This compares our number (blue bar) to all U.S. hospitals (gray bar) reporting to the CathPCI Registry*.

    3. Door-to-balloon time in 2014

    Door-to-balloon time

Average door-to-balloon time for UK Gill Heart Institute patients is 62 minutes compared to 60 minutes for all hospitals. Both are within the 50th percentile.


    View a text summary of this graph » 

    This shows how quickly we treat our patients. It is the average time from a patient entering the hospital to getting PCI. A lower time is better. Our goal is to save the heart muscle: When we can open the artery fast, the patient will likely have a better outcome. It should lead to less heart damage, fewer complications and higher survival rates. This chart compares our time (blue bar) to all U.S. hospitals (gray bar) reporting to the CathPCI Registry*.


    4. Appropriateness of PCI in 2014

    Appropriateness of PCI in 2014

The first graph shows procedures for patients with acute coronary syndrome. The appropriateness of treatment at UK Gill Heart Institute is 99.56% compared to the U.S, average of 98.80%.

The second graph shows procedures for non-acute coronary syndrome patients. The appropriateness of treatment at UK Gill Heart Institute is 79.17% compared to to the U.S, average of 50.14%.


    View a text summary of these graphs » 

    Presence of plaque or blockage in a coronary artery does not always mean it needs a PCI procedure. Some blockages can be treated effectively with medication alone. It is important that we perform PCI only when appropriate. The American College of Cardiology defines an appropriate PCI procedure as:

    • An acceptable and reasonable treatment, and
    • Likely to improve the patient’s health or survival. 

    There are 80 different factors we report to help show that PCI was the right treatment. These include:

    • Medical history.
    • Medication therapy at home.
    • Non-invasive studies: cardiac imaging and stress testing.
    • Clinical presentation.
    • Cardiac angiography findings and extend of the coronary artery disease. 

    The first graph shows procedures for patients with acute coronary syndrome, usually requiring urgent or emergent procedures. The appropriateness at the Gill Heart Institute (blue line) is above 99% for those patients.  

    The second graph shows procedures to non-acute coronary syndrome patients. These patients usually have chest pain caused by activity, and their procedures tend to be planned in advance. The appropriateness at the Gill Heart Institute (blue line) exceeds the 90th percentile, which means the GHI is in the top 10% of all catheterization laboratories reporting the CathPCI Registry*.

    Fractional flow reserve

    Not all blockages need stents or surgery because many blockages do not affect blood flow. For PCI to be the most appropriate care, blockages must be significant.

    It is not always easy to determine whether a blockage is significant enough and whether the patient will benefit from the PCI procedure. Fractional flow reserve (FFR) is a technique that measures pressure differences across blockages to determine if they are significant enough to require stenting or surgery. Using FFR to help physicians decide how to treat a blockage improves outcomes and reduces risk of complications.

    This graph shows the use of FFR in the Gill Heart Institute (blue bar) in comparison to all U.S. hospitals (gray bar) reporting to the CathPCI Registry*. To ensure appropriateness of the treatment, we use FFR measurement much more frequently to help physicians make the most accurate decision. 

    Fractional flow reserve

The third graph shows the use of FFR at 56% in the Gill Heart Institute in comparison to 24% in all U.S. hospitals.


    View a text summary of this graph » 

    5. Patient centeredness: radial access in 2014

    PCI procedures can be performed via the femoral (groin) artery or the radial (wrist) artery. PCI performed via the radial artery is associated with lower risk of bleeding and complications. It is also more convenient as it does not require the patient to lie flat on their back during recovery. For these reasons, there is a growing trend to use radial access in as many patients and procedures as possible.

    GHI cardiologists have adopted radial access as the primary access for performing PCI. The graph shows how the Gill Heart Institute (blue bars) is ahead of the pace and steadily increasing compared to the rest of the catheterization laboratories (gray bars) reporting to CathPCI Registry*. 

    Radial access in 2014

This graph shows the progress increase in adoption of radial access. In 2012 UK Gill Heart Institute used radial access as the primary access for performing PCI in 18.9% of patients compared to 15.3% in all hospitals.

In 2013 UK Gill Heart Institute used radial access as the primary access for performing PCI in 43.2% of patients compared to 20.3% in all hospitals.

In 2014 UK Gill Heart Institute used radial access as the primary access for performing PCI in 52.0% of patients compared to 28.0% in all hospitals.

    View a text summary of these graphs »

    * Data Source: 

    The American College of Cardiology’s CathPCI Registry® University of Kentucky Institutional Outcomes Report for years 2012, 2013 and 2014. The CathPCI Registry is the only nationwide outcomes-based quality-improvement program for hospitals performing percutaneous cardiac intervention procedures. The Registry includes more than 1,500 participating hospitals.


  • Heart attack care

      UK Healthcare - CM Heart Attack  

    PCI within 90 minutes of arrival 

    Oxygen is delivered to the heart via blood vessels. When one of those blood vessels becomes blocked, the heart muscle does not get enough oxygen and a heart attack may result. When this happens, restoring blood flow quickly can lessen damage to the heart. Percutaneous Coronary Interventions (PCIs) are one way doctors clear blockages to get blood flowing to the heart again. There are three procedures included in the term PCI. They are: 

    • Angioplasty – inflation of a balloon within the blood vessel 
    • Stenting – insertion of a wire tube to hold open the vessel 
    • Atherectomy – use of a blade or laser to cut through and clear the blockage  

    Aspirin at discharge 

    People who have had one heart attack are at high risk for another. Aspirin helps keep blood clots from forming and lowers the risk of another attack. (Note: Aspirin can have other negative side effects such as stomach inflammation; if you think you need an aspirin regimen, talk to your doctor first.)  

    Prescription for a statin at discharge  

    Statins are medications that lower cholesterol levels in the blood. Multiple clinical studies have shown that statin medications reduce the risk of repeat heart attacks and death in people who have had a heart attack.  

    About core measures

    Core measures are a set of evidence-based, scientifically researched processes or standards of care that are designed to improve outcomes for patients. Hospitals nationwide use these same core measures, which were established by the Center for Medicare & Medicaid Services (CMS) in 2000. Our goal is to provide this “best practice” care to all of our patients and to make sure it is documented accurately. By tracking our performance on these measures we can see how well we’re doing and identify areas that might need improvement.

  • Heart failure care

    UK Healthcare - CM Heart Failure 

    Patients given discharge instructions  

    Heart failure patients who leave the hospital with clear instructions on how to take care of themselves have better outcomes. These instructions include information on: 

    1. Diet  

    2. Medications  

    3. Appropriate level of activity  

    4. Follow-up appointments  

    5. Making sure to weigh themselves regularly  

    6. What to do if symptoms worsen 

    Patient given an evaluation of LVS function 

    The proper treatment for heart failure depends on what area of the heart is affected. A left ventricular systolic (LVS) function assessment tells the doctor how well the left side of the heart is pumping. 

    The assessment may include an echocardiogram, a physical examination, a chest x-ray, and/or blood work. 

    Patient given an ACE inhibitor or ARB for left ventricular systolic dysfunction 

    ACE inhibitors (angiotensin-converting-enzyme inhibitors) and ARBs (angiotensin II receptor blockers) are medications that block a hormone in the body that causes blood vessels to narrow. They help lower blood pressure and reduce how hard the heart needs to work. Heart failure patients who receive these medications have a significantly lower risk of death.  

     About core measures

    Core measures are a set of evidence-based, scientifically researched processes or standards of care that are designed to improve outcomes for patients. Hospitals nationwide use these same core measures, which were established by the Center for Medicare & Medicaid Services (CMS) in 2000. Our goal is to provide this “best practice” care to all of our patients and to make sure it is documented accurately. By tracking our performance on these measures we can see how well we’re doing and identify areas that might need improvement.
     

  • 2013 ICD Registry Data for UK HealthCare

    ICD stands for “implantable cardioverter-defibrillator.” A doctor places it under the skin. It has wires that run to the heart. They are used to:

    • Prevent death from cardiac arrest.
    • Help patients with heart rhythm problems.

    At UK HealthCare, we report placement data to the ICD Registry. This allows us to compare patient data with other hospitals nationally. It is also a measure of our quality of care.

    Below are three sets of data (metrics) on ICD patients.

    1. Was implanting an ICD appropriate for the patient?

    There are recommended guidelines for the use of ICDs. They are based on research. The guidelines weigh the benefits and risks of ICD placement. Here are the guidelines for appropriate treatment:

    • Class I: The benefits significantly outweigh the risks. ICD should be placed.
    • Class IIa: The benefits outweigh the risks. It is reasonable to place the ICD.
    • Class IIb: The benefits are equal to or greater than the risks. Placing an ICD may be considered.

    ICD illustration 1

    This graph shows the patients that received an ICD for classes I, IIa and IIb in 2013. A higher number is better. The average performance for U.S. hospitals reporting to ICD Registry is 91.5%. Our score is marked by the blue arrow.

    2. Were there complications after the placement?

    Risk-Adjusted Complications is a set of data that shows the number of deaths or related health problems for ICD patients. It looks at the time frame from implantation to discharge. The data takes into account each patient’s health problem.

    ICD illustration 2

    Here, a lower score is better. The average performance for U.S. hospitals reporting to ICD Registry is 1.51% Risk-Adjusted Complication rate. Our number is shown by the blue arrow. 

    3. Did the ICD patients get the right medicines?

    Studies show that ICD patients do better when they take the right medicines at home. Three medicines recommended for ICD patients are ACE inhibitors (angiotensin converting enzyme inhibitors), ARBs (angiotensin receptor blockers), and beta blockers. 

    ICD illustration 3

    This graph shows what part of the eligible patients receive these medicines on discharge. A higher number is better. This compares us to all U.S. hospitals reporting to the ICD Registry. The average performance for U.S. hospitals reporting to ICD Registry is 80.6%. Our number is shown by the blue arrow. 

    * Data Source: 

    The American College of Cardiology’s ICD Registry® University of Kentucky Institutional Outcomes Report for year 2013. The ICD Registry is the only nation wide outcomes-based quality improvement program for hospitals performing implantable cardioverter-defibrillator procedure. There were 1385 US Hospitals submitting data to the ICD Registry in 2013.

  • Cardiovascular Rehabilitation Data for public reporting

    Research shows that cardiac rehabilitation programs help participants live longer. It can also help prevent future heart attacks and admissions to the hospital. Organizations for health professionals recognize cardiac rehabilitation as the standard of care. Information about the cardiac rehabilitation program at the Gill Heart Institute can be found here.

    In 2014, 48 patients completed the full cardiac rehabilitation program. The charts below, based on data we report to the American Association of Cardiovascular and Pulmonary Rehabilitation registry, show the benefits to patients on discharge from the cardiac rehabilitation program.

    Measure Outcomes for 2014

    Systolic Blood Pressure

    gill-chart

    High blood pressure is a serious health problem. It can lead to other issues, including organ failure, heart disease and stroke. You learn two numbers when your blood pressure is checked. The top number is the systolic pressure. This is the pressure when the heart beats. Optimal systolic blood pressure is less than 120. Cardiac rehab can help bring blood pressure into a healthy range.

    Six-Minute Walk Distance

    gill-quality-chart

    The six-minute walk test measures how far you can walk in six minutes. It gives your doctor an idea of how much physical activity you can handle. Patients may have this test before and after rehab programs to measure improvement. Walking a longer distance for six minutes is better. Cardiac rehab can help patients live more active lives.

    Quality of Life

    gill-heart-chart

    The purpose of cardiac rehab is to improve patients’ physical and emotional well-being. Patients fill out a patient health questionnaire before and after rehab. The higher score is better. The results show that rehab helps improve the quality of life for patients with heart problems.

    * Data Source:
    The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) University of Kentucky Institutional Outcomes Report for year 2014.