Critical pathways for management of patients with acute coronary syndromes: an assessment by the National Heart Attack Alert Program.
BACKGROUND
The use of critical pathways for a variety of clinical conditions has grown rapidly in recent years, particularly pathways for patients with acute coronary syndromes (ACS). However, no systematic review exists regarding the value of critical pathways in this setting.


METHODS
The National Heart Attack Alert Program established a Working Group to review the utility of critical pathways on quality of care and outcomes for patients with ACS. A literature search of MEDLINE, cardiology textbooks, and cited references in any article identified was conducted regarding the use of critical pathways for patients with ACS.


RESULTS
Several areas for improving the care of patients with ACS through the application of critical pathways were identified: increasing the use of guideline-recommended medications, targeting use of cardiac procedures and other cardiac testing, and reducing the length of stay in hospitals and intensive care units. Initial studies have shown promising results in improving quality of care and reducing costs. No large studies designed to demonstrate an improvement in mortality or morbidity were identified in this literature review.


CONCLUSIONS
Critical pathways offer the potential to improve the care of patients with ACS while reducing the cost of care. Their use should improve the process and cost-effectiveness of care, but further research in this field is needed to determine whether these changes in the process of care will translate into improved clinical outcomes.
Cannon
Christopher P
CP
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
Hand
Mary H
MH
Bahr
Raymond
R
Boden
William E
WE
Christenson
Robert
R
Gibler
W Brian
WB
Eagle
Kim
K
Lambrew
Costas T
CT
Lee
Thomas H
TH
MacLeod
Bruce
B
Ornato
Joseph P
JP
Selker
Harry P
HP
Steele
Pamela
P
Zalenski
Robert J
RJ
D000208:Acute Disease; D000789:Angina, Unstable / Q000175:diagnosis* / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003325:Coronary Care Units; D019091:Critical Pathways / Q000145:classification / Q000592:standards*; D006801:Humans; D007902:Length of Stay; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy*; D013577:Syndrome; D015912:Thrombolytic Therapy / Q000592:standards
D000925:Anticoagulants; D001241:Aspirin