Study objective: To determine the impact of a critical pathway on acute myocardial infarction (AMI) quality indicators.
Design: Retrospective chart review.
Setting: Large university hospital.
Patients: One hundred seventy-five patients who underwent primary percutaneous transluminal angioplasty for AMI (control group 89 patients, intervention group 86 patients).
Measurements and main results: The medical records of the control group (1998-1999) were reviewed for door-to-balloon (DtB) time (the time between the patient's arrival at the emergency department and the first balloon inflation during a percutaneous transluminal coronary angioplasty procedure). Drug therapy prescribed at hospital discharge (aspirin, beta-blocker, angiotensin-converting enzyme [ACE] inhibitor, and lipid-lowering therapy) was also reviewed. The data collected for the control group were compared with the intervention group data (2000-2001). The impact of the pathway was evaluated using the Wilcoxon rank sum test, odds ratios (ORs), and chi2 tests. The DtB time was significantly lower in the intervention group versus the control group (91.5 vs 108 min, p < 0.01), and fewer intervention patients exceeded the guidelines with a DtB time longer than 120 minutes (OR 0.38, p < 0.01). In addition, the intervention group was more likely than the control group to be prescribed an ACE inhibitor (OR 3.7, p < 0.01) or lipid-lowering therapy (OR 3.7, p = 0.02) at discharge. Aspirin and beta-blockers were not prescribed differently in the intervention versus control groups (aspirin 95.2% vs 96.2%, beta-blockers 93.5% vs 92.6%).
Conclusion: These data suggest that in the current era of published treatment guidelines, implementation of a critical pathway can further improve AMI quality indicators and clinical care.