Top-scoring hospitals for heart surgery

Last spring, when Zvi Frankel’s grandfather learned that a valve in his heart needed to be replaced, he turned to his grandson for help.

The grandfather, who lives in New York City, had to choose between the standard open-heart surgery and a less invasive, high-tech version. The new option, called trans­catheter aortic valve replacement, was appealing. He wouldn’t have to be placed on a heart-lung machine or have his heart temporarily stopped.

But Frankel and his grandfather wanted to know more. Which worked best long term? Which was safer? And most important, which hospitals and surgeons had the best results? “Doesn’t everyone want to know that when they face something as serious as heart surgery?” Frankel asks.

Well, most people probably do want that information. But, as Frankel found out, getting it is far from easy. In fact, Frankel embarked on what turned into a long quest, ending with him writing an article in JAMA Internal Medicine on how difficult it was for consumers to find needed information.

Along the way he found that many hospitals were eager to talk about the benefits of the new procedure, which involves inserting an artificial valve through an incision in the groin and threading it up an artery to the heart. Several hospitals even promoted it in ads or website videos, such as one we found from New York-Presbyterian hospital in New York City narrated by Mehmet Oz, M.D., director of the hospital’s Cardiovascular Institute.

But the hospitals and surgeons could not or would not tell Frankel what he most wanted to know. It took weeks poring over medical journals to learn that the limited research to date suggests that although the procedure can be the only option for some very sick people, it may be more likely than the traditional approach to cause some serious complications. He found that those ​increased ​risks included the need for a pacemaker and death from aortic regurgitation, triggered when blood leaks around the new valve and back into the heart.

Most difficult was learning how well particular doctors and hospitals performed. In fact, he ended up filing a Freedom of Information Act request with New York state to get success rates for the doctors and hospitals they were considering. Ultimately, his grandfather chose the traditional approach, performed by a surgeon with a good track record at Weill Cornell Medical Center in New York City, according to the data from the state registry. The surgery was a success.

“It shouldn’t be so hard,” says John Santa, M.D., medical director of Consumer Reports Health, who helped Frankel publish his article. “Not everyone has a grandson like Zvi to act as a full-time medical detective. Hospitals and doctors should make the information accessible and understandable, so families can make informed choices when they make life and death decisions.”

Our first ever Ratings of hospitals for heart surgery are an attempt to help you do just that.

We have rated more than 400 hospitals in 45 states plus Washington, D.C.,  on heart surgery. Go to our hospital Ratings to find those that are near you. Use the search tool to compare up to five hospitals. For details on a specific hospital, click on its name, then scroll down the page until you see the heading "Heart Surgery." You can also download a PDF of our heart surgery Ratings.

We rate hospitals on two heart surgeries: surgical aortic valve replacement, the kind chosen by Frankel’s grandfather; and coronary artery bypass graft surgery, an equally serious operation done to treat blocked coronary arteries. (Read more about how to treat heart disease.)

The Ratings are based on the gold standard in tracking hospital performance: data from patients’ medical records showing whether patients survived the procedure and how they fared on other important measures, including complications. To create a level playing field, the data are adjusted for the health of patients because certain hospitals treat more older, sicker patients than others.

The information comes from the Society of Thoracic Surgeons (STS), which represents physicians who operate on the heart and other organs in the chest. The STS has collected the data for several decades. More than 1,000 U.S. hospitals report to the STS, but only about 400 allowed the organization to share the data with us.

“All hospitals know this information,” Santa says. “Those that have agreed to share, especially those with low scores, should be applauded for their commitment to transparency. Those that haven’t shared should make it available—otherwise, it seems like they have something to hide.”

Here are some of our main findings:

• Certain famous hospitals are missing. They aren’t in our Ratings because they don’t share data with us, the STS, or both. That includes two hospitals Frankel’s grandfather considered, Columbia-Presbyterian and Weill Cornell. Also on that list: Cedars-Sinai Medical Center in Los Angeles, Johns Hopkins Hospital in Baltimore, and the Mayo Clinic in Rochester, Minn.
• Top hospitals are in surprising places. Only 15 hospitals in our Ratings earned top scores in heart-valve and bypass surgeries. Although the well-known Cleveland Clinic made the list, so did some less familiar hospitals, such as Borgess Medical Center in Kalamazoo, Mich., and Mother Frances Hospital-Tyler in Tyler, Texas. Some are major medical centers; others are smaller. “It’s not name or location or ad budget that matters; it’s a commitment to quality, and that can happen anywhere,” Santa says.
• Performance varies widely, even at neighboring hospitals. We found four metro­politan areas—Indianapolis, Los Angeles, Oklahoma City, and Portland, Ore.—where there are top- and low-scoring hospitals, sometimes just miles apart. “In those communities, the hospital you choose can really make a difference,” Santa says.
• Many hospitals do a good job. Of the hospitals that shared their bypass data with us, 20 percent (83) were above average, 75 percent (310) were average, and 4 percent (18) were below average. The STS has high standards, so hospitals with average scores still do a very good job, says Robbin Cohen, M.D., an associate professor of cardiothoracic surgery at the Keck School of Medicine at the University of Southern California and a member of the STS. Of the 247 hospitals with data on valve surgery, 10 percent (25) got a top score, 87 percent (216) a middle score, and 2 percent (6) the lowest one.

Only 15 of the hospitals that share their data with us earned top marks in bypass and valve surgeries ­(listed alphabetically)€:

• Baystate Medical Center, Springfield, Mass.
• Borgess Medical Center, Kalamazoo, Mich.
• Cleveland Clinic, Cleveland
• The Heart Hospital Baylor Plano, Plano, Texas
• Kaiser Permanente Sunnyside Medical Center, Clackamas, Ore.
• Kaleida Health (Gates Vascular Institute at
  Buffalo General Medical Center), Buffalo, N.Y.
• Mother Frances Hospital-Tyler, Tyler, Texas
• St. Joseph Mercy Hospital, Ypsilanti, Mich.
• St. Joseph’s Hospital Health Center, Syracuse, N.Y.
• St. Vincent Heart Center of Indiana, Indianapolis
• Sequoia Hospital, Redwood City, Calif.
• Spectrum Health - Grand Rapids (Meijer
  Heart Center), Grand Rapids, Mich.
• Swedish Medical Center-Cherry Hill Campus, Seattle
• UMass Memorial Medical Center, Worcester, Mass.
• Valley Hospital, Ridgewood, N.J.

No one undergoes heart surgery lightly.

Bypass is usually reserved for people with multiple coronary arteries blocked with plaque, which increases the risk of heart attack and causes chest pain and shortness of breath. During the procedure, the surgeon opens the chest, removes part of a healthy vein or artery from another part of the body, and grafts one end of it below the clog and the other end above it, allowing blood flow to bypass the blockage.

Aortic valve replacement is mostly done when the valve in the heart’s left chamber accumulates calcium deposits, obstructing blood flow. Over time, the heart fails as it struggles to keep blood pumping.

Even in the hands of skilled surgeons at good hospitals, the procedures can sometimes lead to heart attack, kidney failure, or other problems. After surgery, patients are put on a ventilator, which increases the risk of complications, including pneumonia and other infections.

“No surgeon and no hospital can do heart surgery with zero complications and zero deaths,” Cohen says. “Patients undergo heart surgery because the benefits outweigh the risks.” But as our Ratings show, results vary among hospitals. So which hospital you choose matters.

Frankel ultimately got enough information to make a decision, but he says that efforts such as our new heart Ratings would have helped. When confronting surgery, people need to know they are making a decision based on facts, Frankel says. “You can choose the best doctor and best hospital, and you still may not have positive results,” he says. “But people should be able to know they did everything they possibly could.”

1. Isn't heart surgery always an emergency? Do I even have time to research hospitals?

If you are having a heart attack, emergency bypass surgery is sometimes necessary. But in most cases heart disease can be stabilized with drugs or simpler procedures, giving you, or a friend or family member, time. Ask your doctor how serious your condition is and how soon you’ll need surgery. Valve disease is serious but rarely an emergency, so you will almost always have time.

2. What should I do if my hospital isn’t rated?

There’s a good chance of that happening, because many hospitals did not share data with us. But almost every hospital reports to the Society of Thoracic Surgeons, even if the information is not public. Some that do report to the STS give similar data to state registries. So ask your surgeon about the hospital’s survival and complication rates. If he or she can’t—or won’t—share it, consider looking elsewhere.

3. What should I do if no top hospitals are in my community?

First, don’t panic. A hospital that gets an average rating still provides good care. If all hospitals in your area get low scores or won’t share their data, you could travel elsewhere. But check with your insurance to make sure the procedure will be covered at the out-of-town hospital. And realize that you might not have as much support from family and friends. If you choose a lower-rated hospital, discuss your concerns about its score with your surgeon. That can be reassuring and help you prepare for your stay.

4. Do I need to go to a famous hospital or one in a large city to get good care?

No. We found top hospitals in bypass and valve surgery in out-of-the-way places. And high-scoring hospitals in one or the other procedure are in all regions of the country.

5. What if my insurer won’t cover the hospital I want?

If you have original Medicare, you should have no problem, because almost all hospitals accept it. With managed care, including Medicare Advantage, you must use providers in the plan’s network or you’re likely to pay all or most of the costs out of your own pocket. If the surgery can be postponed for several months, you could consider switching plans for 2015. That may not be possible if you’re covered through a job, but if you have Medicare Advantage or a plan you bought through a state marketplace, you can switch plans during the annual fall open enrollment period.

6. What if I also want information about my heart surgeon?

That can be difficult to find. We have Ratings for heart surgery groups but not individual doctors. A few states maintain registries for surgeons. (Contact your state’s department of health.) But you probably will need to ask your surgeon for the information you want. If he or she won’t tell you, consider going elsewhere.  

The data come from the Society of Thoracic Surgeons for hospitals that have agreed to share their information with us.

Bypass surgery Ratings

Reflects a hospital’s performance in isolated coronary artery bypass graft surgery, including the open-heart approach and less invasive versions. Overall score is a composite of four measures: survival (percentage of patients who leave the hospital and survive at least 30 days after surgery), complications (percentage of patients who avoid the most serious complications, including needing a second operation, developing a deep chest infection, suffering a stroke or kidney failure, and requiring prolonged ventilation), best surgical technique (percentage of patients who receive at least one graft from an internal mammary artery, located under the breastbone, which improves survival), and right drugs (percentage of patients who receive beta-­blockers before and after surgery to control blood pressure and heart rhythm, aspirin to prevent blood clots, and a drug after surgery to lower LDL (bad) cholesterol).

Valve replacement Ratings

Reflects a hospital’s performance in surgical aortic valve replacement. Does not include data for trans­catheter aortic valve replacement, though the STS has started to collect it. Overall score is a composite of two measures: survival (percentage of patients who leave the hospital and survive at least 30 days after surgery) and complications (percentage of patients who avoid the most serious complications, which are the same as for bypass).

All data were adjusted based on the health of patients. Still, limitations of such adjustments can make direct comparisons difficult.

This article also appeared in the August 2014 issue of Consumer Reports magazine.

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