Carlhed Rickard, Bojestig Mats, Peterson Anette, Aberg Christina, Garmo Hans, Lindahl Bertil
Department of Cardiology and Uppsala Clinical Research Center, University Hospital, Uppsala, Sweden.
Circ Cardiovasc Qual Outcomes. 2009 Sep;2(5):458-64. doi: 10.1161/CIRCOUTCOMES.108.842146. Epub 2009 Sep 1.
The Swedish quality improvement initiative Quality Improvement in Coronary Care previously demonstrated significant improvements in caregiver adherence to national guidelines for acute myocardial infarction. The associated impact on 1-year clinical outcome is presented here.
During the baseline period July 2001 to June 2002, 6878 consecutive acute myocardial infarction patients <80 years were included at the 19 intervention and 19 control hospitals and followed for a mean of 12 months. During the postintervention period of May 2003 to April 2004, 6484 patients were included and followed in the same way. From baseline to postintervention, improvements in mortality and cardiovascular readmission rates (events per 100 patient-years) were significant in the intervention group (-2.82, 95% CI -5.26 to -0.39; -9.31, 95% CI -15.48 to -3.14, respectively). However, in the control hospitals, there were no significant improvements (0.04, 95% CI -2.40 to 2.47; -4.93, 95% CI -11.10 to 1.24, respectively). Bleedings in the control group increased in incidence (0.92, 95% CI 0.41 to 1.43), whereas the incidence remained unchanged in the intervention group (0.07, 95% CI -0.44 to 0.58). When the difference of changes between the study groups were evaluated, the results still were in favor of the intervention group, albeit significant only for bleeding complications (mortality: -2.70, 95% CI -6.37 to 0.97; cardiovascular readmissions: -6.85, 95% CI -16.62 to 2.93; bleeding complications: -0.82, 95% CI -1.66 to 0.01).
With a systematic quality improvement initiative aiming to increase the adherence to acute myocardial infarction guidelines, it is possible to achieve long-term positive effects on clinical outcome.
瑞典的冠状动脉护理质量改进倡议先前已证明，护理人员对急性心肌梗死国家指南的依从性有显著提高。本文介绍了对1年临床结局的相关影响。
在2001年7月至2002年6月的基线期，19家干预医院和19家对照医院纳入了6878例年龄小于80岁的连续急性心肌梗死患者，并平均随访12个月。在2003年5月至2004年4月的干预后期，纳入了6484例患者并以同样方式进行随访。从基线期到干预后期，干预组的死亡率和心血管再入院率（每100患者年的事件数）有显著改善（分别为-2.82，95%可信区间-5.26至-0.39；-9.31，95%可信区间-15.48至-3.14）。然而，在对照医院中，没有显著改善（分别为0.04，95%可信区间-2.40至2.47；-4.93，95%可信区间-11.10至1.24）。对照组的出血发生率增加（0.92，95%可信区间0.41至1.43），而干预组的发生率保持不变（0.07，95%可信区间-0.44至0.58）。当评估研究组之间变化的差异时，结果仍然有利于干预组，尽管仅出血并发症有显著差异（死亡率：-2.70，95%可信区间-6.37至0.97；心血管再入院：-6.85，95%可信区间-16.62至2.93；出血并发症：-0.82，95%可信区间-1.66至0.01）。
通过旨在提高对急性心肌梗死指南依从性的系统性质量改进倡议，有可能对临床结局产生长期积极影响。
