Expanding use of thrombolytic therapy in the treatment of acute myocardial infarction in rural Alaskan hospitals.

This paper focuses on clinical quality improvement comparing the results of two studies done approximately one year apart on treatment of acute myocardial infarction in four rural hospitals. The purpose of both studies was to determine how often eligible, elderly Medicare patients with acute myocardial infarction received thrombolytic treatment and aspirin. The studies were done by abstracting medical records for the calendar year 1993 and again in the year between October 1, 1994 and September 30, 1995. The results show that the use of thrombolytic therapy in these hospitals for the Medicare population increased by 40% between 1993 and 1995, a statistically significant increase (95% confidence intervals (CI) 20.1% to 60.0%). The rate of thrombolytic therapy among eligible Medicare patients went from 25.5% in 1993 to 65.7% in 1995. The use of aspirin also increased by 12.5% which was borderline significant (95% CI, 0.0% to 34%). The results were not as dramatic because the baseline for aspirin use with acute myocardial infarction was already 67.5% in 1993. These results indicate that the treatment of acute myocardial infarction is evolving closely in line with the American Heart Association/American College of Cardiology 1996 guidelines. Studies of clinical quality improvement such as this are now requirements for hospital certification.