Impact of a critical pathway on acute myocardial infarction quality indicators.
OBJECTIVE
To determine the impact of a critical pathway on acute myocardial infarction (AMI) quality indicators.


METHODS
Retrospective chart review.


METHODS
Large university hospital.


METHODS
One hundred seventy-five patients who underwent primary percutaneous transluminal angioplasty for AMI (control group 89 patients, intervention group 86 patients).


RESULTS
The medical records of the control group (1998-1999) were reviewed for door-to-balloon (DtB) time (the time between the patient's arrival at the emergency department and the first balloon inflation during a percutaneous transluminal coronary angioplasty procedure). Drug therapy prescribed at hospital discharge (aspirin, beta-blocker, angiotensin-converting enzyme [ACE] inhibitor, and lipid-lowering therapy) was also reviewed. The data collected for the control group were compared with the intervention group data (2000-2001). The impact of the pathway was evaluated using the Wilcoxon rank sum test, odds ratios (ORs), and chi2 tests. The DtB time was significantly lower in the intervention group versus the control group (91.5 vs 108 min, p < 0.01), and fewer intervention patients exceeded the guidelines with a DtB time longer than 120 minutes (OR 0.38, p < 0.01). In addition, the intervention group was more likely than the control group to be prescribed an ACE inhibitor (OR 3.7, p < 0.01) or lipid-lowering therapy (OR 3.7, p = 0.02) at discharge. Aspirin and beta-blockers were not prescribed differently in the intervention versus control groups (aspirin 95.2% vs 96.2%, beta-blockers 93.5% vs 92.6%).


CONCLUSIONS
These data suggest that in the current era of published treatment guidelines, implementation of a critical pathway can further improve AMI quality indicators and clinical care.
University of Colorado Hospital, Department of Clinical Pharmacy, School of Pharmacy, University of Colorado Health Sciences Center, 80262, USA.
Megan B
MB
Bestul
Marianne
M
McCollum
Kathleen A
KA
Stringer
Jeb
J
Burchenal
D000208:Acute Disease; D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D015906:Angioplasty, Balloon, Coronary; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D019091:Critical Pathways / Q000592:standards*; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008055:Lipids / Q000097:blood; D008499:Medical Records; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy; D010349:Patient Compliance; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013997:Time Factors
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000960:Hypolipidemic Agents; D008055:Lipids; D001241:Aspirin