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In your health today, ranking the top hospitals for treating heart problems. U.S. News and World Report releases its annual list of the 50 best hospitals tomorrow. The ratings generate a lot of buzz. But as NPR's Allison Aubrey reports, this is not necessarily a list that people at risk of heart attacks should follow.

ALLISON AUBREY: Doctor Harlan Krumholz is a heart specialist at Yale University who's always been curious about the U.S. News and World Report rankings. He says when his hospital makes the list, Yale makes a big to-do about it.

Dr. HARLAN KRUMHOLZ (Yale University): You know, we take out ads and there are banners around. And if people don't know about it, we try to let them know about it. I mean hospitals themselves, when they're on the list, try to take advantage of it and use it as a way to market. But the question that people might have is, well, you know, how well does this rating system really characterize the performance of my institution?

AUBREY: And Krumholz translated that question into how many patients who come to the E.R. with a heart attack survive and live at least a month? To get the answer, Krumholz analyzed the U.S. News rankings from 2003. At the top of the magazine's list were prestigious institutions, including Hopkins, Harvard, Emory and Stanford. Then Krumholz got data from that same year on heart attack deaths at more than 3,000 hospitals around the nation.

Overall, he says 35 of the U.S. News hospitals were in the top rank on heart attack survival.

Dr. KRUMHOLZ: What it shows is that the ranking system, which by and large, is built to a substantial extend on reputation and identifies some of the most famous and well-known institutions in the country, did a pretty good job of picking out the hospitals that do significantly better than expected.

AUBREY: But there are several important caveats. The first is that on average the top hospitals didn't do much better than all the rest. Sixteen percent of heart attack patients treated at the U.S. News hospitals died compared to 17.9 percent at all the others. What's more, four hospitals out of U.S. News's top 50 had heart attack mortality rates that were among the nation's worst.

Dr. KRUMHOLZ: The mere fact of being famous or well known or having high prestige or having a lot of technology doesn't guarantee that patients are going to get the best care.

AUBREY: The editors of U.S. News and World Report say they're gratified that 35 out of their 50 made Krumholz's top rank. But editor Avery Comarow, who supervises the annual ranking, says his review is not designed to rate hospitals on how well they treat heart attacks.

Mr. AVERY COMAROW (Editor, U.S. News and World Report): When we survey doctors, we specifically request that they list as many as five hospitals that they consider best in their specialty for patients with difficult or complicated cases, regardless of location or expense.

AUBREY: Difficult or complicated cases means things like heart transplants, bypass surgery or implanting pacemakers. In ranking hospitals for these complicated heart disease treatments, U.S. News does consider a few other criteria.

The magazine looks at the number of procedures performed, deaths in the hospital related to those procedures, and quality of care measures such as the nurse-to-patient ratio and the number of key technologies in use. But they don't count what happens with heart attacks.

Dr. HOWARD HERMANN (University of Pennsylvania): I think any indicator or ranking of a hospital has to take into account multiple facets of that hospital's care.

AUBREY: Howard Hermann is a cardiologist at the University of Pennsylvania. He says both U.S. News and the Yale analysis are too narrow. So what are they good for? The U.S. News rankings may be helpful for the sickest patients whose cardiac care is complicated by old age, frailty, or other diseases. The Yale analysis would be more helpful if you wanted to know how quickly and effectively a given hospital responds to emergency heart attack patients.

Dr. HERMANN: So no single ranking or indicator of a hospital is going to tell you everything you need to know about that hospital.

AUBREY: Ratings, rankings and scorecards are published by state agencies, Medicare, nonprofit organizations, academic researchers and the media. Yale's Harlan Krumholz says outcome measurements are a big advance over relying on reputation alone.

Dr. KRUMHOLZ: The real reason that you do this is so that hospitals and clinicians and everyone involved in health care can take a long hard look at how they do, how they do compared to others, and figure out what they can do better.

AUBREY: And that's the real value of report cards.

Allison Aubrey, NPR News, Washington.

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