University Hospital Besancon, Boulevard Fleming, 25000 Besancon, France.
University of Leeds, Leeds, UK.
Eur Heart J Acute Cardiovasc Care. 2021 Apr 8;10(2):224-233. doi: 10.1093/ehjacc/zuaa037.
Quality indicators (QIs) are tools to improve the delivery of evidence-base medicine. In 2017, the European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC) developed a set of QIs for acute myocardial infarction (AMI), which have been evaluated at national and international levels and across different populations. However, an update of these QIs is needed in light of the accumulated experience and the changes in the supporting evidence.
The ESC methodology for the QI development was used to update the 2017 ACVC QIs. We identified key domains of AMI care, conducted a literature review, developed a list of candidate QIs, and used a modified Delphi method to select the final set of indicators. The same seven domains of AMI care identified by the 2017 Study Group were retained for this update. For each domain, main and secondary QIs were developed reflecting the essential and complementary aspects of care, respectively. Overall, 26 QIs are proposed in this document, compared to 20 in the 2017 set. New QIs are proposed in this document (e.g. the centre use of high-sensitivity troponin), some were retained or modified (e.g. the in-hospital risk assessment), and others were retired in accordance with the changes in evidence [e.g. the proportion of patients with non-ST segment elevation myocardial infarction (NSTEMI) treated with fondaparinux] and the feasibility assessments (e.g. the proportion of patients with NSTEMI whom risk assessment is performed using the GRACE and CRUSADE risk scores).
Updated QIs for the management of AMI were developed according to contemporary knowledge and accumulated experience. These QIs may be applied to evaluate and improve the quality of AMI care.
质量指标（QIs）是提高循证医学实践的工具。2017 年，欧洲心脏病学会（ESC）急性心血管护理协会（ACVC）为急性心肌梗死（AMI）制定了一套 QIs，这些 QIs 已经在国家和国际层面以及不同人群中进行了评估。然而，鉴于积累的经验和支持证据的变化，这些 QIs 需要更新。
我们使用 ESC 的 QI 开发方法更新了 2017 年 ACVC 的 QIs。我们确定了 AMI 护理的关键领域，进行了文献回顾，制定了候选 QIs 列表，并使用改良 Delphi 方法选择最终的指标集。2017 年研究小组确定的七个 AMI 护理领域在本次更新中得以保留。对于每个领域，主要和次要 QIs 分别反映了护理的基本和补充方面。总的来说，本文件提出了 26 个 QIs，而 2017 年的文件中提出了 20 个。本文件中提出了一些新的 QIs（例如，中心使用高敏肌钙蛋白），一些被保留或修改（例如，院内风险评估），其他则根据证据变化（例如，接受非 ST 段抬高型心肌梗死（NSTEMI）治疗的患者比例，使用依诺肝素）和可行性评估（例如，使用 GRACE 和 CRUSADE 风险评分对 NSTEMI 患者进行风险评估的比例）而退役。
根据当代知识和积累的经验，制定了更新的 AMI 管理 QIs。这些 QIs 可用于评估和改善 AMI 护理质量。
