title: Effect of implementing an acute myocardial infarction guideline on quality indicators.
abstract: OBJECTIVE
  To evaluate the compliance rates to quality of care indicators along the implementation of an acute myocardial infarction clinical practice guideline.
  
  
  METHODS
  A clinical guideline for acute myocardial infarction was introduced on March 1st, 2005. Patients admitted for acute myocardial infarction from March 1st, 2005 to December 31st, 2012 (n=1,431) were compared to patients admitted for acute myocardial infarction before the implementation of the protocol (n=306). Compliance rates to quality of care indicators (ASA prescription on hospital admission and discharge, betablockers on discharge and door-to-balloon time) as well as the length of hospital stay and in-hospital mortality were compared before and after the implementation of the clinical guideline.
  
  
  RESULTS
  The rates of ASA prescription on admission, on discharge and of betablockers were higher after guideline implementation: 99.6% versus 95.8% (p<0.001); 99.1% versus 95.8% (p<0.001); and 95.9% versus 81.7% (p<0.001), respectively. ASA prescription rate increased over time, reaching 100% from 2009 to 2012. Door-to-balloon time after versus before implementation was of 86(32) minutes versus 93(51) (p=0.20). The length of hospital stay after the implementation versus before was of 6(6) days versus 6(4) days (p=0.34). In-hospital mortality was 7.6% (before the implementation), 8.7% between 2005 and 2008, and 5.3% between 2009 and 2012, (p=0.04).
  
  
  CONCLUSIONS
  The implementation of an acute myocardial infarction clinical practice guideline was associated with an increase in compliance to quality of care indicators.
authors.forename: Marcia
authors.initials: M
authors.lastname: Makdisse
authors.forename: Marcelo
authors.initials: M
authors.lastname: Katz
authors.forename: Alessandra da Graça
authors.initials: Ada G
authors.lastname: Corrêa
authors.forename: Luciano Monte Alegre
authors.initials: LM
authors.lastname: Forlenza
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Perin
authors.forename: Fábio Sândoli
authors.initials: FS
authors.lastname: de Brito Júnior
authors.forename: Teresa Cristina Dias Cunha
authors.initials: TC
authors.lastname: Nascimento
authors.forename: Ivanise Maria
authors.initials: IM
authors.lastname: Gomes
authors.forename: Marcelo
authors.initials: M
authors.lastname: Franken
authors.forename: Marcos
authors.initials: M
authors.lastname: Knobel
authors.forename: Antonio Eduardo Pereira
authors.initials: AE
authors.lastname: Pesaro
authors.forename: Oscar Fernando Pavão
authors.initials: OF
authors.lastname: dos Santos
authors.forename: Miguel
authors.initials: M
authors.lastname: Cendoroglo Neto
authors.forename: Claudio Luiz
authors.initials: CL
authors.lastname: Lottenberg
mesh_terms: D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D019984:Quality Indicators, Health Care / Q000592:standards* / Q000706:statistics & numerical data; D016896:Treatment Outcome