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

Mapping Intimacies ◽

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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Quality Evaluation in Delivering Care of Acute Myocardial Infarction in Sancti-spirítus, Cuba

10.21203/rs.3.rs-33820/v1 ◽

2020 ◽

Author(s):

Miguel Alejandro Rodriguez-Ramos ◽

Gilberto Cairo-Saez ◽

Juan Antonio Prohias-Martinez

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Quality Of Care ◽

Secondary Prevention ◽

Middle Income ◽

Quality Markers ◽

St Elevation ◽

European Society Of Cardiology

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 and future priorities for delivering acute myocardial infarction care in Sri Lanka

Heart ◽

10.1136/heartjnl-2019-315396 ◽

2019 ◽

Vol 106 (8) ◽

pp. 603-608

Author(s):

Walithotage Gotabhaya Ranasinghe ◽

Abi Beane ◽

Thamal Dasitha Palligoda Vithanage ◽

Gamage Dona Dilanthi Priyadarshani ◽

Don Dhanushka Eranga Colombage ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Quality Of Care ◽

Risk Model ◽

Coronary Intervention ◽

Tertiary Hospital ◽

Bleeding Complications ◽

Continuous Measure ◽

Middle Income

AimThis study evaluates the quality of care for patients admitted with acute myocardial infarction (AMI) in a tertiary hospital in Colombo using the European Society of Cardiology Quality of Care Working Group’s guidelines (2017).MethodsA recently implemented electronic AMI registry m-Health tool was used for prospective data collection. Each patient was assessed for eligibility for each of the six domains of quality. Global Registry of Acute Coronary Events Risk Model for predicted probability of mortality, and scores for risk of bleeding complications (CRUSADE) and severity of heart failure (Killip classification) were calculated as per published guidelines. A composite measure of quality was derived from compliance with the six domains. Patients were followed up via telephone at 30 days following discharge to evaluate outcome and satisfaction. Organisational information was assessed by administrative review and interview.ResultsBetween March 2017 and April 2018, 934 patients with AMI presented to the cardiology department. The majority of patients (90.4%) presented with features of ST-elevation myocardial infarction (STEMI). Mean (SD) overall compliance with the composite quality indicator (CQI) was 44% (0.07). Compliance of ≥50% to the CQI was achieved in 9.8% of STEMI patients. The highest compliance was observed for antithrombotics during hospitalisation (79.1%) and continuous measure of patient satisfaction (76.1%). The lowest compliance was for organisational structure and care processes (22.4%).ConclusionThis study reports a registry-based continuous evaluation of the quality of AMI care from a low and middle-income country. Priorities for improvement include improved referral, and networking of primary and secondary health facilities with the percutaneous coronary intervention centre.

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

Revista Española de Cardiología (English Edition) ◽

10.1016/j.rec.2011.12.005 ◽

2012 ◽

Vol 65 (5) ◽

pp. 401-402

Author(s):

Christiaan J.M. Vrints

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Quality Of Care ◽

Secondary Prevention ◽

Medical Treatment

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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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