Key result
AMI guideline adherence varies across academic medical centers by up to ~13 percentage points.
Why the study?
Does the hospital of admission affect the quality of care and adherence to clinical guidelines for patients with acute myocardial infarction?
Cross-Sectional (n=577)
Yes
Does the hospital of admission affect the quality of care and adherence to clinical guidelines for patients with acute myocardial infarction?
The study highlights significant inter-hospital variability in the delivery of evidence-based treatments for acute myocardial infarction, underscoring the need for continuous quality improvement initiatives.
Hospital variation in AMI guideline adherence warrants ongoing monitoring; leaves open whether targeted quality initiatives can reduce disparities.
Objectives. The objective of our study was to assess hospital variations in the quality of care delivered to acute myocardial infarction (AMI) patients among three Swiss academic medical centres. Design. Cross-sectional study. Setting. Three Swiss university hospitals. Study participants. We selected 1129 eligible patients discharged from these hospitals from 1 January to 31 December 1999, with a primary or secondary diagnosis code [International Classification of Diseases, 10th revision (ICD-10)] of AMI. We abstracted medical records for information on demographic characteristics, risk factors, symptoms, and findings at admission. We also recorded the main ECG and laboratory findings, as well as hospital and discharge management and treatment. We excluded patients transferred to another hospital and who did not meet the clinical definition of AMI. Main outcome measures. Percentage of patients receiving appropriate intervention as defined by six quality of care indicators derived from clinical practical guidelines. Results. Among 577 eligible patients with AMI in this study, the mean (SD) age was 68.2 (13.9), and 65% were male. In the assessment of the quality indicators we excluded patients who were not eligible for the procedure. Among cohorts of âideal candidates' for specific interventions, 64% in hospital A and 73% in hospital C had reperfusion within 12 hours either with thrombolytics or percutaneous transluminal coronary angioplasty (P = 0.367). Further, in hospitals A, B, and C, respectively 97, 94, and 84% were prescribed aspirin during the initial hospitalization (P = 0.0002), and respectively 68, 91, and 75% received angiotensin converting enzyme inhibitors at discharge in the case of left ventricular systolic dysfunction (P = 0.003). Conclusions. Our results showed important hospital-to-hospital variations in the quality of care provided to patients with AMI between these three university hospitals
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Luthi et al. (2005) conducted a cross-sectional in Acute myocardial infarction (AMI) (n=577). Hospital of admission vs. Comparison among three different university hospitals was evaluated on Percentage of patients receiving appropriate interventions as defined by six quality of care indicators derived from clinical guidelines. Significant hospital-to-hospital variations existed in the quality of care provided to AMI patients, with adherence to guideline-derived interventions like aspirin within 24 hours ranging from 84.6% to 97.2% across three academic medical centers.
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