Implementing clinical guidelines on acute myocardial infarction care in an emergency service.
BACKGROUND
The implementation of clinical guidelines on acute myocardial infarction (AMI) care produces better results.


OBJECTIVE
To present a multidisciplinary program to implement these guidelines in a large public emergency center and check its impact.


METHODS
Evaluation study on health services, with "before and after" type design, to assess the indicators of quality of AMI care before and after implementation of training strategies and to facilitate emergency teams' acceptance of clinical guidelines. This includes the development of educational and awareness-raising materials and continued supervision. Relative risk estimate (RR) and confidence intervals (95%).


RESULTS
Pre-program group, 78 cases of AMI; post-program group, 66 cases of AMI. Most cases were treated only in the emergency room, due to small number of vacancies in the coronary care unit. We observed a significant increase (p<0.05) in the use of various interventions evaluated (process indicators): beta-blockers, 83%; angiotensin-converting enzyme inhibitors, 22%; lipid-lowering agents, 69%; intravenous nitrate, 55%; coronary reperfusion in acute myocardial infarction with ST-segment elevation, 98%. The use of aspirin from the first day of the IAM reached 95.5% of cases. The loss of opportunity of coronary reperfusion in patients with this indication, reduced from 71.4% to 17.6% post-training.


CONCLUSIONS
The program achieved a significant impact and its propagation to other units may contribute to better assist IAM in the public health system.
Hospital dos Servidores do Estado/Ministério da Saúde, Rio de janeiro, RJ, Brazil. c.escosteguy@cardiol.br
Claudia Caminha
CC
Escosteguy
Alfredo Brasil
AB
Teixeira
Margareth Crisostomo
MC
Portela
Artur Eduardo Cotrim
AE
Guimarães
Sheyla Maria Lemos
SM
Lima
Vanja Maria Bessa
VM
Ferreira
Claudia
C
Brito
D000208:Acute Disease; D000368:Aged; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006296:Health Services / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D017410:Practice Guidelines as Topic