Improving Quality of Care of Acute Myocardial Infarction: More Focus Needed on Long-Term Optimal Medical Treatment and Secondary Prevention

Abstract Background: Prevalence of cardiac conditions is increasing worldwide. Low and middle-income scenario (LMISs), especially in Latin America, don’t scape from this phenomenon. To give a high-quality cardiovascular disease care may be economic challenging for these countries, in every level of attention.Methods: Observational and retrospective study of quality of care evaluation using the European Society of Cardiology (ESC 2017) Quality of Care Working Group’s consensus on quality document, of admitted Acute Myocardial Infarction in a General Hospital in Sancti-Spiritus, Cuba.Results: Between 2017 and 2019, 660 patients with AMI were admitted, most of them (72%), presented with features of ST-elevation myocardial infarction. Thrombolytics were administered to 268 (72.4%) patients, 43 (16%) of them in less than 30 minutes after diagnosis. Double antiplatelet treatment was administered to 98.1% of patients at admission. However, only 163 (34.8%) were enrolled in secondary prevention programs. No information regarding Patient Experience, nor 30-day adjusted mortality, was collected. Secondary prevention was fulfilled around 90%Conclusion: Determination of the quality metrics brought some improvement for the perception of the actual quality of care in this low/middle income scenario. Pre-hospital quality markers need to be improved, before trying to introduce a higher level of treatment.

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Quality evaluation in delivering care of Acute Myocardial Infarction in Sancti-Spirítus, Cuba.

10.21203/rs.3.rs-33820/v2 ◽

2020 ◽

Author(s):

Miguel Alejandro Rodriguez-Ramos ◽

Gilberto Cairo-Saez ◽

Juan Prohias-Martinez

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Quality Of Care ◽

Secondary Prevention ◽

General Hospital ◽

Coronary Intervention ◽

Middle Income ◽

Esc Guidelines ◽

European Society Of Cardiology

Abstract Aim: This study assesses the quality of care for patients admitted with diagnosis of acute myocardial infarction (AMI) in a secondary general hospital located in Sancti-Spiritus, Cuba, in a low/middle income scenario (LMIS), using the 2017 European Society of Cardiology (ESC) Quality of Care Working Group’s guideline.Methods: Observational retrospective of admitted AMI in Sancti-Spiritus Camilo Cienfuegos General Hospital. An implemented electronic registry was used for data collection. Each patient was considered for eligibility for each of the eight domains of quality. A set of quality measures was derived from ESC guidelines. Organizational information was assessed by administrative review and interview.Results: Between 2017 and 2019, 660 patients with AMI were admitted to Camilo Cienfuegos General Hospital, most of them (72%), presented with features of ST-elevation myocardial infarction (STEMI). Thrombolytic were administered to 268 (72.4%) patients, 43 (16%) of them in less than 30 minutes of diagnosis. Dual Antiplatelet Therapy was administered to 98.1% of patients on admission. However, only 163 (34.8%) were enrolled in secondary prevention programs. No information regarding Patient Experience, nor 30-day adjusted mortality, was collected. Secondary prevention was accomplished, around 90%.Conclusion: Determination of quality metrics brought certain improvement on perception of the quality of care in this setting. Despite absence of coronary intervention, there is a chance to modify some performance measures, which are not directly related with this doubtful situation.

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The impact of sex, gender and healthcare system on quality of care among young adults with acute myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.3175 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

V Raparelli ◽

L Pilote ◽

H Behlouli ◽

J Dziura ◽

H Bueno ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Young Adults ◽

Quality Of Care ◽

Healthcare System ◽

Quality Indicators ◽

Funding Source ◽

Post Discharge ◽

Single Payer

Abstract Background The quality of care among young adults with acute myocardial infarction (AMI) may be related to biological sex, psycho-socio-cultural (gender) determinants or healthcare system-level factors. Purpose To examine whether sex, gender, and the type of healthcare system influence the quality of AMI care among young adults. Methods A total of 4,564 AMI young adults (<55 years) (59% women, 47 years, 66% US) were analyzed from the VIRGO and GENESIS-PRAXY studies consisting of single-payer (Canada, Spain) versus multipayer (US) systems. For each patient treated in each system we calculated a quality of care score (QCS) for pre-AMI (1-year pre admission), in-hospital, and post-AMI (1-year post discharge) phases of care (number of quality indicators received divided by the total number [range=0–100%], with higher scores indicating better quality). Ordinal logistic or linear regression models, and 2-way interactions between sex, gender and healthcare system were tested. Results Women in the multipayer system had the highest risk factor burden. Across the phases of care for AMI, 20% of quality indicators were missed in both sexes. High stress, earner status, and social support were associated with a higher QCS in the pre-AMI phase, whereas only employment and earner status were associated with QCS in all other phases. In the pre-AMI phase, women had higher QCS than men, mainly in the single-payer system (adjusted-OR=1.85, 95% CI 1.46,2.35 vs. 1.07, 95% CI 0.84,1.36, P-interaction= 0.002). Regardless of sex, only employment status had a greater effect in the multipayer system (adjusted-OR=0.59, 95% CI 0.44,0.78 vs 1.13, 95% CI 0.89,1.44, P-interaction <0.001). In the in-hospital phase, women had a lower QCS than men, especially in the multipayer system (adjusted-mean-difference: −2.48, 95% CI-3.87, −1.08). Employment was associated with a higher QCS (2.0, 95% CI 0.9–3.17, P-interaction >0.05). Finally, in the post-AMI phase, men and women had a lower QCS, predominantly in the multipayer system. However, primary earners had higher QCS regardless of system. Conclusion Sex, gender, and healthcare system affected the quality of care after AMI. Women had a poorer in-hospital than men and both women and men had suboptimal post-discharge care. Being unemployed lowered the quality of care, more so in the multipayer system. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health and Research (CIHR)

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Timeliness and Quality of Care for Elderly Patients With Acute Myocardial Infarction Under Health Maintenance Organization vs Fee-for-Service Insurance

Archives of Internal Medicine ◽

10.1001/archinte.159.17.2013 ◽

1999 ◽

Vol 159 (17) ◽

pp. 2013 ◽

Cited By ~ 19

Author(s):

Stephen B. Soumerai ◽

Thomas J. McLaughlin ◽

Jerry H. Gurwitz ◽

Steven Pearson ◽

Cindy L. Christiansen ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Quality Of Care ◽

Elderly Patients ◽

Health Maintenance Organization ◽

Fee For Service ◽

Health Maintenance

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Trends in quality of care for patients with acute myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006

American Heart Journal ◽

10.1016/j.ahj.2008.07.028 ◽

2008 ◽

Vol 156 (6) ◽

pp. 1045-1055 ◽

Cited By ~ 163

Author(s):

Eric D. Peterson ◽

Bimal R. Shah ◽

Lori Parsons ◽

Charles V. Pollack ◽

William J. French ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Quality Of Care ◽

National Registry

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Abstract 110: Long-Term Health Status Outcomes in Young Women with Acute Myocardial Infarction: Results from the VIRGO Study

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.110 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Rachel P Dreyer ◽

Kelly M Strait ◽

Judith H Lichtman ◽

Nancy Lorenze ◽

Gail D'Onofrio ◽

...

Keyword(s):

Quality Of Life ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Health Status ◽

Young Women ◽

Short Form ◽

P Values ◽

Poor Outcome

Background: Despite the excess risk of mortality in young women following acute myocardial infarction (AMI), little effort has been made to describe their long-term outcomes, particularly with respect to their health status (symptoms, function and quality of life). Accordingly, we assessed gender differences in 1-year health status outcomes after AMI. Methods: Data was used from the VIRGO study, an observational cohort of patients aged ≤55 years with AMI in the US and Spain (n=3,501, 67% women). Clinical data was abstracted from medical records and health status was obtained through patient interviews at the time of hospitalization and at 1-year later [Short Form 12 (SF-12) and the Seattle Angina Questionnaire (SAQ)]. Patient scores were categorized as “bad” if they had below average scores on the SF-12 components, had a score below 100 on the SAQ physical limitations (PL) or the SAQ angina frequency (AF), or had a score below 75 on the SAQ quality of life (QOL) at either baseline or 1-year. Patients were classified as having a “poor” outcome for a measure if they had a “bad” score at both baseline and 1-year or had a “bad” score at 1-year. Logistic regression models were used to assess factors associated with having a “poor” outcome for each scale. Results: The median age was 48 years (IQR: 44, 52). Women were more likely to present with diabetes (39% vs. 27%), obesity (51% vs. 45%), stroke (5% vs. 2%), heart failure (5% vs. 2%), lung disease (13% vs. 5%), and depression (48% vs. 24%, all P values <0.0001). Women were more likely to have “poor outcomes” compared with men (SF-12 PCS 46% vs. 30%; SF-12 MCS 47% vs. 30%; SAQ AF 32% vs. 25%; SAQ PL 29% vs. 20%; SAQ QOL 42% vs. 28%, all p-values <0.001). Female gender, prior AMI/percutaneous coronary intervention/coronary artery bypass grafting, and smoking within 30 days were independent predictors of having a “poor” outcome for all health status measures. Specifically, women had an increased odds of having a “poor” outcome on the SF-12 PCS (OR=2.05; 95% CI 1.69, 2.48), MCS (OR=1.98; 95% CI 1.65, 2.39), SAQ AF (OR=1.39; 95% CI 1.15, 1.67), SAQ PL (OR=1.62; 95% CI 1.32, 1.99) and the SAQ QOL scale (OR=1.84; 95% CI 1.53, 2.22), as compared with men. Conclusion: Compared with men, young women are more likely to have “poor” health status outcomes after AMI. This information is critically important in developing targets for gender-specific interventions to improve young women’s recovery post AMI.

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