Lana Maria Letícia L, Beaton Andrea Z, Brant Luisa C C, Bozzi Isadora C R S, de Magalhães Osias, Castro Luiz Ricardo de A, da Silva Júnior Francisco César T, da Silva José Luiz P, Ribeiro Antonio Luiz P, Nascimento Bruno R
Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Avenida Professor Alfredo Balena 110, Belo Horizonte, MG 30130-100, Brazil.
Children's National Health System, 111 Michigan Ave NW, Washington, DC 20010, USA.
Int J Qual Health Care. 2017 Aug 1;29(4):499-506. doi: 10.1093/intqhc/mzx059.
To evaluate compliance with American Heart Association/American College of Cardiology (AHA/ACC) performance measures for adults with acute myocardial infarction (AMI) and to investigate the factors associated with compliance, in an AMI System of Care in Brazil.
Observational longitudinal study.
A high-complexity University Hospital, part of the AMI System of Care implemented in Belo Horizonte, Brazil, in 2010.
Of note, 1129 patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) admitted to a single center over 36 months (between 2011 and 2014).
Compliance with 13 pre-specified AHA/ACC AMI performance measures was evaluated for patients with AMI, observing exclusion criteria and appropriate numerators and denominators. Median compliance was calculated and variables independently associated with compliance rates were evaluated.
Median age was 60 (51/68) years, 67.7% male, 69.8% presented with STEMI and hospital mortality was 8.7%. Median compliance with performance measures was 83% (75/88). Among patients with STEMI, 56% received reperfusion therapy. Overall, 67.3% of patients complied with ≥80% of quality measures. Factors independently associated with better compliance were later date of presentation (semester), likely reflecting ongoing training (OR = 1.19, 95% CI: 1.10-1.28, P < 0.001), male gender (OR = 1.33, 95% CI: 1.00-1.76, P < 0.046), Killip I/II on admission (OR = 1.95, 95% CI: 1.36-2.80, P < 0.001) and diagnosis of NSTEMI (OR = 5.0, 95% CI: 3.51-7.11, P < 0.001).
Compliance with AHA/ACC AMI performance measures remains below target in Brazil, but the time trends observed suggest improvement. Continuing education, reduction of system delays and prioritizing high-risk groups are needed to optimize AMI systems of care and improve patient outcomes.
在巴西的急性心肌梗死（AMI）护理系统中，评估成人急性心肌梗死患者对美国心脏协会/美国心脏病学会（AHA/ACC）绩效指标的依从性，并调查与依从性相关的因素。
观察性纵向研究。
一家高复杂性大学医院，是2010年在巴西贝洛奥里藏特实施的AMI护理系统的一部分。
值得注意的是，在36个月（2011年至2014年）期间，1129例ST段抬高型心肌梗死（STEMI）和非ST段抬高型心肌梗死（NSTEMI）患者入住单一中心。
对AMI患者评估其对13项预先指定的AHA/ACC AMI绩效指标的依从性，观察排除标准以及适当的分子和分母。计算中位依从性，并评估与依从率独立相关的变量。
中位年龄为60（51/68）岁，男性占67.7%，STEMI患者占69.8%，医院死亡率为8.7%。绩效指标的中位依从性为83%（75/88）。在STEMI患者中，56%接受了再灌注治疗。总体而言，67.3%的患者符合≥80%的质量指标。与更好的依从性独立相关的因素是就诊日期较晚（学期），这可能反映了持续培训（OR = 1.19，95%CI：1.10 - 1.28，P < 0.001）、男性性别（OR = 1.33，95%CI：1.00 - 1.76，P < 0.046）、入院时Killip I/II级（OR = 1.95，95%CI：1.36 - 2.80，P < 0.001）和NSTEMI诊断（OR = 5.0，95%CI：3.51 - 7.11，P < 0.001）。
在巴西，对AHA/ACC AMI绩效指标的依从性仍低于目标，但观察到的时间趋势表明有所改善。需要持续教育、减少系统延误并优先关注高危人群，以优化AMI护理系统并改善患者结局。
