When it comes to treating patients with acute myocardial infarction, electronic health records have had a positive impact, despite a few minor drawbacks in implementing the technology, according to a recent report.
In the report, published online Oct. 20 in the American Heart Association journal “Circulation: Cardiovascular Quality and Outcomes,” researchers looked at data from the American Heart Association’s Get With the Guidelines ACTION Registry and an annual survey by the American Hospital Association. The study included 124,826 patients from 414 participating facilities.
Researchers found that in non-ST-segment-elevation myocardial infraction, there was a slightly lower adjusted risk of major bleeding and mortality among patients admitted to hospitals using full EHR systems. But for patients with ST-segment-elevation myocardial infraction, no differences in outcomes were discovered, according to the study. At the same time, use of EHR was linked to less heparin overdosing and slightly greater commitment to acute myocardial infraction guideline-recommended therapies. Patients were more likely to receive defect-free care when treated at hospitals with either partial or fully implemented EHRs than patients at hospitals without EHRs, the study found.
EHR use has expanded significantly in recent years, growing from 82.1% of hospitals in 2007 to 99.3% of hospitals in 2010, study authors noted. EHRs were a major part of healthcare reform, with national legislation in 2009 promoting their widespread use in US hospitals.
“EHR use was associated with some markers of patient safety, such as less frequent heparin overdosing, and slightly greater use of evidence-based therapies,” study authors wrote. “However, associations with adverse outcomes after MI were mixed. Further determination of the optimal methods of EHR utilization is likely needed to leverage more consistent gains across AMI quality of care and outcomes.”
Still, EHR use could contribute to a lower risk of AMI mortality risk because of their association with higher quality AMI care, including less heparin overdosing and patients receiving more evidence-based care, the study reported. Researchers pointed to previous investigations showing that every 10% increase in adherence to a composite of AMI core measures corresponded to a 10% reduction in in-hospital mortality but said those numbers only explained a small percentage in mortality variations. AMI outcomes also are tied to treatments that occur near the end or after hospitalization, such as discharge medication, smoking cessation counseling and cardiac rehab referral, according to the study.
“However, EHRs could still influence other elements of acute care for AMI and, thus, improve AMI outcomes,” the authors write. “It is also possible that unmeasured residual confounders, in part, may contribute to the observed differences in bleeding and mortality outcomes.”
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