einstein (São Paulo). 01/Sep/2013;11(3):357-63.

Effect of implementing an acute myocardial infarction guideline on quality indicators

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

DOI: 10.1590/S1679-45082013000300016

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.

Effect of implementing an acute myocardial infarction guideline on quality indicators

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