What Makes a 'Best' Heart Hospital?

And when do you need one? Our Q&A will tell you—and offer tips on how to get in if you do.

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If you needed a good hospital for especially high-quality heart-related care, what would you do? Would you go wherever your doctor sends you, figuring she knows best? That's what most people do. But your doctor might not know best. Patients with challenging heart problems are routinely referred to hospitals with limited experience in dealing with them—situations like diagnosing and treating a rare heart rhythm, or inserting a stent in a tortuous coronary artery, or replacing a dangerously leaky aortic valve. By contrast, patients with thorny problems are not at all uncommon at the heart and heart surgery centers ranked in the latest edition of Best Hospitals, released last month by U.S. News & World Report. The bigger the problem, the more urgent the need to seek out a hospital like those in the rankings. One or more is likely to be within a short flight or a reasonable drive. The 50 heart hospitals in the latest heart rankings are scattered across 24 states and the District of Columbia, and the top 10, listed here, are in nine different pockets of the country. Following the list is guidance on understanding the qualities of an excellent heart hospital, deciding whether you need one, and explaining how to get in if you do.

The Best Hospitals in Heart & Heart Surgery

Rank

  1. Cleveland Clinic
  2. Mayo Clinic, Rochester, Minn.
  3. Johns Hopkins Hospital, Baltimore
  4. Texas Heart Institute at St. Luke's Episcopal Hospital, Houston
  5. Massachusetts General Hospital, Boston
  6. New York-Presbyterian University Hospital of Columbia and Cornell
  7. Brigham and Women's Hospital, Boston
  8. Ronald Reagan UCLA Medical Center, Los Angeles
  9. Duke University Medical Center, Durham, N.C.
  10. Hospital of the University of Pennsylvania, Philadelphia
  11. [See full list of Best Hospitals in Heart & Heart Surgery]

    What makes these hospitals the best?


    They do difficult cases—and lots of them. Take coronary artery bypass surgery, the most common major heart procedure. The rankings don't factor in care of low-risk bypass patients—only those who are very sick or who come to the OR with major complications that pose added risk, like diabetes or a bleeding disorder. Such patients are overrepresented at ranked hospitals because that is where they are more likely to be referred or transferred. To even be considered for the 2010-11 rankings in heart and heart surgery, a hospital had to have treated at least 1,244 high-risk heart patients, 500 of them surgical cases, based on the latest three years of Medicare data. Out of 4,852 hospitals in the nation, just 670—not even 15 percent—made the cut. But only 50 of the 670 are ranked. How do the ranked hospitals stand out?


    A quick scan of the top 10 might suggest that it's because of their reputation. More than 70 percent of the cardiologists and heart surgeons who responded to U.S. News surveys over the last three years, for example, nominated the Cleveland Clinic as one of the places they would send their most difficult heart patients if money and geography were not issues. A closer look beyond the top 10 or so, however, shows that reputation generally is not the key. Of the remaining 40 hospitals, 21 were cited by no more than 2 percent of the specialists; six hospitals got no nominations at all. The numbers tell the story: Ranked hospitals generally had lower death rates, higher nursing standards, and a commitment to advanced technology. Their average mortality ratio of 0.69 means that heart patients died about 30 percent less often than would be expected for their age, severity of their condition, and other risk factors; by comparison, the mortality ratio at several unranked hospitals was above 1.50—a death rate more than 50 percent higher than expected. Nearly three-fourths of the ranked facilities are recognized by the American Nurses Credentialing Center as "Nurse Magnet" hospitals for their high-quality nursing care, a distinction that only about one in 15 U.S. hospitals can claim. Two-thirds of the ranked hospitals have all seven of the heart-related technologies U.S. News considers important in caring for high-risk patients, such as a separate cardiac intensive-care unit, a PET/CT scanner, and transplant services—and most of the others have six. Many unranked hospitals have three or fewer of the items on the list.