Systematic quality control for management of ST elevation acute myocardial infarction in setting of local network.
OBJECTIVE
Adherence to evidence based guidelines, assessed by measuring key indicators, allows to detect, evaluate and improve quality of care. Since 2004 in Carlo Poma Hospital, following the introduction of a network for ST-elevation myocardial infarction (STEMI) management, the authors carried out a clinical database in order to measure quality of care in STEMI patients.


METHODS
A real time upgradable database was developed, to assess clinical practice in myocardial infarction management. The authors evaluated prevalence and control of risk factors, pharmacological therapies and interventional procedures, pathways and delays to care.


RESULTS
From 1 February 2004 to 31 January 2008, 1,714 consecutive patients with myocardial infarction were admitted in the Intensive Care Unit (ICU). Primary percutaneous coronary intervention (PCI) was performed in 85% of STEMI patients. Door to balloon time was greater than 90 min in only 17% of patients, of whom 88% coming from emergency department and 12% transferred by 118.


CONCLUSIONS
In the authors' experience quality indicators proved useful in the management of myocardial infarction. Implementation of 118 and improvement of pre-hospital diagnosis in setting of local network can reduce time to treatment.
Zanini
R
R
Division of Cardiology, "Carlo Poma" Hospital, Mantova, Italy. roberto.zanini@ospedalimantova.it
Buffoli
F
F
Tomasi
L
L
Izzo
A
A
Lettieri
C
C
Cicorella
N
N
Romano
M
M
Aroldi
M
M
Belfanti
D
D
D000368:Aged; D003628:Database Management Systems; D016208:Databases, Factual; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D011786:Quality Control; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards*