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Comparative Study
. 2013 Jul-Sep;11(3):357-63.
doi: 10.1590/s1679-45082013000300016.

Effect of implementing an acute myocardial infarction guideline on quality indicators

[Article in English, Portuguese]
Marcia Makdisse, Marcelo Katz, Alessandra da Graça Corrêa, Luciano Monte Alegre Forlenza, Marco Antonio Perin, Fábio Sândoli de Brito Júnior, Teresa Cristina Dias Cunha Nascimento, Ivanise Maria Gomes, Marcelo Franken, Marcos Knobel, Antonio Eduardo Pereira Pesaro, Oscar Fernando Pavão dos Santos, Miguel Cendoroglo Neto, Claudio Luiz Lottenberg
Comparative Study

Effect of implementing an acute myocardial infarction guideline on quality indicators

[Article in English, Portuguese]
Marcia Makdisse et al. Einstein (Sao Paulo). 2013 Jul-Sep.

Abstract
in English, Portuguese

Objective: To evaluate the compliance rates to quality of care indicators along the implementation of an acute myocardial infarction clinical practice guideline.

Methods: A clinical guideline for acute myocardial infarction was introduced on March 1st, 2005. Patients admitted for acute myocardial infarction from March 1st, 2005 to December 31st, 2012 (n=1,431) were compared to patients admitted for acute myocardial infarction before the implementation of the protocol (n=306). Compliance rates to quality of care indicators (ASA prescription on hospital admission and discharge, betablockers on discharge and door-to-balloon time) as well as the length of hospital stay and in-hospital mortality were compared before and after the implementation of the clinical guideline.

Results: The rates of ASA prescription on admission, on discharge and of betablockers were higher after guideline implementation: 99.6% versus 95.8% (p<0.001); 99.1% versus 95.8% (p<0.001); and 95.9% versus 81.7% (p<0.001), respectively. ASA prescription rate increased over time, reaching 100% from 2009 to 2012. Door-to-balloon time after versus before implementation was of 86(32) minutes versus 93(51) (p=0.20). The length of hospital stay after the implementation versus before was of 6(6) days versus 6(4) days (p=0.34). In-hospital mortality was 7.6% (before the implementation), 8.7% between 2005 and 2008, and 5.3% between 2009 and 2012, (p=0.04).

Conclusion: The implementation of an acute myocardial infarction clinical practice guideline was associated with an increase in compliance to quality of care indicators.

Objetivo:: Avaliar a adesão aos indicadores de qualidade assistencial ao longo da implementação de um protocolo assistencial de infarto agudo do miocárdio.

Métodos:: Em 1º de março de 2005 foi implementado o protocolo assistencial de infarto agudo do miocárdio. Foram selecionados pacientes admitidos de 1º de março de 2005 a 31 de dezembro de 2012 (n=1.431). Para comparação, utilizamos os dados de pacientes admitidos por infarto na fase pré-protocolo (n=306). Comparamos a taxa de adesão aos indicadores (taxa de prescrição de AAS na admissão hospitalar e na alta hospitalar, betabloqueador na alta e tempo porta-balão) entre as fases pré e pós-implementação do protocolo, além de tempo de permanência hospitalar e mortalidade intra-hospitalar nas diferentes fases.

Resultados:: As taxas de prescrição de AAS na admissão e na alta hospitalar, e de betabloqueador foram maiores na fase pós versus a pré-implementação do protocolo: 99,6% versus 95,8% (p<0,001); 99,1% versus 95,8% (p<0,001) e 95,9% versus 81,7% (p<0,001), respectivamente. A taxa de prescrição de AAS aumentou ao longo da implementação do protocolo, atingindo 100% de 2009 a 2012. O tempo porta-balão pós versus pré foi de 86(32) minutos versus 93(51), respectivamente (p=0,20). O tempo de permanência hospitalar foi semelhante na fase pré versus pós-protocolo: 6(6) dias versus 6(4) dias (p=0,34). A mortalidade intra-hospitalar foi de 7,6% no pré-protocolo, 8,7% entre 2005 e 2008 e 5,3% entre 2009 e 2012 (p=0,04).

Conclusão:: A implementação do protocolo assistencial refletiu-se na maior adesão aos indicadores de qualidade.

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Conflict of interest statement

Conflicts of interest: none.

Figures

Figure 1
Figure 1. Rate of prescription of acetylsalicylic acid on discharge based on guideline implementation phase
Figure 2
Figure 2. Rate of in-hospital mortality during guideline implementation phases
See this image and copyright information in PMC

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