Ospedale Cà Foncello, Treviso, Italy.
Eur Heart J Acute Cardiovasc Care. 2012 Jun;1(2):143-52. doi: 10.1177/2048872612450520.
To assess and promote compliance of Italian cardiological intensive care units (CCUs) with evidence-based guidelines for the management of acute myocardial infarction (MI).
The process of diagnosis and treatment of MI was prospectively evaluated in 163 CCUs by use of 30 indicators during two enrolment phases, each followed by a feedback of both local and general performance. Overall, 5854 patients with ST-segment elevation MI (STEMI) and 5852 with non-ST-segment elevation MI (NSTEMI) were consecutively enrolled. The target for each indicator was defined as compliance with the relevant recommendations in ≥90% of suitable patients and it was met for nine (30%) and 10 (33.3%) indicators in the first and second phases, respectively. Regardless of target, a significant improvement in compliance was observed in the second phase in 10 out of 30 indicators (33.3%). Use of pre-hospital ECG, expedite delivery of reperfusion therapy, dosage of antithrombotic drugs, and non-pharmacological implementation of secondary prevention were often off target. Similar in-hospital mortality was observed in phases I and II, both in patients with STEMI (4.0 vs. 4.2%, p=0.79) and NSTEMI (1.8 vs. 2.4%, p=0.11). Overall, 30-day mortality were 5.7% for patients with STEMI and 3.4% with NSTEMI.
Performance indicators can accurately weigh the whole process of diagnosis and treatment of patients with MI and monitor the improvements in the quality of care. In our large population of consecutive patients, satisfactory 30-day outcomes were observed despite suboptimal adherence to guidelines for some indicators of recognised prognostic relevance.
评估和促进意大利心脏重症监护病房（CCU）对急性心肌梗死（MI）管理循证指南的遵循情况。
通过使用 30 项指标，在两个入组阶段前瞻性评估 163 个 CCU 中 MI 的诊断和治疗过程，每个阶段之后都会反馈当地和总体表现。共连续入组 5854 例 ST 段抬高型心肌梗死（STEMI）和 5852 例非 ST 段抬高型心肌梗死（NSTEMI）患者。每个指标的目标设定为在≥90%合适患者中符合相关建议，第一和第二阶段分别有 9（30%）和 10（33.3%）个指标达到目标。无论目标如何，在第二阶段，30 个指标中有 10 个（33.3%）的依从性显著提高。院前心电图的使用、尽快实施再灌注治疗、抗血栓药物剂量以及二级预防的非药物实施通常不符合目标。在 STEMI（4.0%比 4.2%，p=0.79）和 NSTEMI（1.8%比 2.4%，p=0.11）患者中，第一和第二阶段的院内死亡率相似。STEMI 患者的总体 30 天死亡率为 5.7%，NSTEMI 患者为 3.4%。
绩效指标可以准确衡量 MI 患者诊断和治疗的整个过程，并监测护理质量的改进。在我们连续入组的大量患者中，尽管某些具有公认预后相关性的指标的指南依从性不理想，但观察到令人满意的 30 天结局。
