Jaber Wissam A, Holmes David R
Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Med Clin North Am. 2007 Jul;91(4):751-68; xii-xiii. doi: 10.1016/j.mcna.2007.03.001.
Coronary artery disease is the number-one killer in developed countries, with lifetime prevalence of up to 50% in American men, and is the topic of much medical literature. Recently, multiple therapies have emerged to save lives after acute myocardial infarction (AMI), backed by well-conducted studies; however, appropriate implementation of therapy guidelines is less than optimal. Recent efforts have focused on improving the quality of care (QC) after AMI in order to improve outcomes. This article illustrates how outcome after AMI is related to QC, describes the underuse of evidence-based therapies, and discusses factors associated with poor guideline adherence. It also reviews current quality improvement projects, and some available means to measure and optimize the QC for patients with AMI.
冠状动脉疾病是发达国家的头号杀手，在美国男性中终身患病率高达50%，也是众多医学文献的主题。最近，在精心开展的研究支持下，出现了多种用于挽救急性心肌梗死（AMI）后患者生命的疗法；然而，治疗指南的恰当实施情况并不理想。最近的努力集中在改善AMI后的医疗质量（QC）以提高治疗效果。本文阐述了AMI后的治疗效果与医疗质量之间的关系，描述了循证疗法的未充分使用情况，并讨论了与指南依从性差相关的因素。文章还回顾了当前的质量改进项目，以及一些可用于衡量和优化AMI患者医疗质量的方法。
