Vnitr Lek 2010, 56(1):21-29

Pilot register of acute myocardial infarction - a 5-year evaluation of quality of care in non-PCI hospitals

Z. Monhart^1,*, H. Grünfeldová², P. Janský³, J. Zvárová⁴, V. Faltus⁴

¹ Interní oddělení Nemocnice Znojmo, přednosta prim. MUDr. Jan Sedláček

² Interní oddělení a Centrum biomedicínské informatiky Městské nemocnice Čáslav, přednostka prim. MUDr. Hana Grünfeldová

³ Kardiovaskulární centrum pro dospělé pacienty Kardiochirurgické kliniky 2. lékařské fakulty a FN Motol Praha, přednosta doc. MUDr. Marek Šetina, CSc.

⁴ Centrum biomedicínské informatiky, Ústav informatiky AV ČR v.v.i., Praha, vedoucí prof. RNDr. Jana Zvárová, DrSc.

Introduction:
The aim of this research was to describe (demographic data and cardiovascular disease risk factors) a non-selected patient population with acute myocardial infarction and to evaluate the applied diagnostic and therapeutic approaches.

Patients and methods:
Data on 3,184 cases of acute myocardial infarction from non-PCI hospitals in Čáslav, Chrudim, Jindřichův Hradec, Kutná Hora, Písek and Znojmo were entered in a pilot register between 2003 and 2007.

Results:
ST elevation myocardial infarctions represented 28.5% of registered cases; primary reperfusion was indicated in 68.3% of these cases. Coronarography was indicated in 43.8% of patients in the non-ST elevation myocardial infarction subgroup. When evaluating pharmacotherapy administered during the first 24 hours following admission, a statistically significant increase in pharmacotherapy administration over the 5 years of register existence was observed (the most apparent for clopidrogel - increase from 24.6% to 63.3%). Analysis of medication recommended for use at discharge also revealed significant increase in administration of the recommended medication over the 5 years in all evaluated drug groups - the most significant, once again, for thienopyridines (increase from 34.9% to 49.6%). In-hospital mortality decreased over the 5 years from 15.2% in 2003 to 8.0% in 2007.

Conclusion:
The 5-year evaluation of diagnostic and therapeutic approaches applied in patients with acute myocardial infarction in non-PCI hospitals confirmed improvement in care provided, specifically improved adherence to pharmacotherapy as well as interventional treatment guidelines pertinent to this patient group. Together with increased quality of care, we observed a decline in in-hospital mortality of patients with acute myocardial infarction.

Keywords: acute myocardial infarction; register; risk factors; quality of care; pharmacotherapy; interventional treatment

Received: July 10, 2009; Accepted: October 16, 2009; Published: January 1, 2010  Show citation