Processes and outcomes for acute myocardial infarction patients

PURPOSE: The purpose of this paper is to determine whether process quality indicators for acute myocardial infarction (AMI) one associated with outcome indicators (hospital mortality and early readmission). DESIGN/METHODOLOGY/APPROACH: A retrospective cohort study was conducted among patients discharged from three Swiss university hospitals with a primary or secondary International Classification of Diseases, 10th revision (ICD-10) AMI code in 1999. A total of 1,129 patients' records were abstructed. Demographic characteristics and risk factors at admission were recorded. The main ECG and laboratory findings were further abstracted as well as hospital and discharge management and treatment. The main outcome measure was process quality indicators derived from evidence-based guidelines, and hospital mortality and early readmissions. FINDINGS: After exclusions, 577 patients with AMI were eligible for this study. The mean (SD) age was 68.2 (13.9). In the assessment of quality indicators patients with potential contra-indications were excluded. Among cohorts of "ideal candidates" for specific interventions, aspirin was not prescribed within 24 hours after admission in 33 (6.2 percent) patients. Among those, 17 (51.5 percent) died (p<0.0001). The adjusted OR for no aspirin after admission was 3.61 (95 percent CI 1.11-11.77) for hospital mortality. Further, 78 (19.5 percent) patients did not receive ß-blockers at discharge. Among them nine (11.5 percent) were readmitted (p=0.133). The adjusted OR for no ß-blockers at discharge was 2.15 (95 percent CI 0.86-5.41) for readmissions. Among patients with AMI, not prescribing aspirin within 24 hours after admission was associated with hospital mortality. However, process indicators derived from evidence-based guidelines were not related to early readmission in this study. ORIGINALITY/VALUE: The paper stresses the importance of clinicians confronting their decisions with recommendations of evidence-based guidelines for the management and treatment of AMI patients