uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Improved clinical outcome after acute myocardial infarction in hospitals participating in a Swedish quality improvement initiative
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. (UCR)
Show others and affiliations
2009 (English)In: Circulation. Cardiovascular quality and outcomes, ISSN 1941-7713, Vol. 2, no 5, 458-464 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Swedish quality improvement initiative Quality Improvement in Coronary Care previously demonstrated significant improvements in caregiver adherence to national guidelines for acute myocardial infarction. The associated impact on 1-year clinical outcome is presented here. METHODS AND RESULTS: During the baseline period July 2001 to June 2002, 6878 consecutive acute myocardial infarction patients <80 years were included at the 19 intervention and 19 control hospitals and followed for a mean of 12 months. During the postintervention period of May 2003 to April 2004, 6484 patients were included and followed in the same way. From baseline to postintervention, improvements in mortality and cardiovascular readmission rates (events per 100 patient-years) were significant in the intervention group (-2.82, 95% CI -5.26 to -0.39; -9.31, 95% CI -15.48 to -3.14, respectively). However, in the control hospitals, there were no significant improvements (0.04, 95% CI -2.40 to 2.47; -4.93, 95% CI -11.10 to 1.24, respectively). Bleedings in the control group increased in incidence (0.92, 95% CI 0.41 to 1.43), whereas the incidence remained unchanged in the intervention group (0.07, 95% CI -0.44 to 0.58). When the difference of changes between the study groups were evaluated, the results still were in favor of the intervention group, albeit significant only for bleeding complications (mortality: -2.70, 95% CI -6.37 to 0.97; cardiovascular readmissions: -6.85, 95% CI -16.62 to 2.93; bleeding complications: -0.82, 95% CI -1.66 to 0.01). CONCLUSIONS: With a systematic quality improvement initiative aiming to increase the adherence to acute myocardial infarction guidelines, it is possible to achieve long-term positive effects on clinical outcome.

Place, publisher, year, edition, pages
2009. Vol. 2, no 5, 458-464 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-124525DOI: 10.1161/CIRCOUTCOMES.108.842146ISI: 000276078200011PubMedID: 20031877OAI: oai:DiVA.org:uu-124525DiVA: diva2:317638
Available from: 2010-05-04 Created: 2010-05-04 Last updated: 2013-01-23Bibliographically approved
In thesis
1. Quality Improvement in Acute Coronary Care: Combining the Use of an Interactive Quality Registry with a Quality Improvement Collaborative to Improve Clinical Outcome in Patients with Acute Myocardial Infarction
Open this publication in new window or tab >>Quality Improvement in Acute Coronary Care: Combining the Use of an Interactive Quality Registry with a Quality Improvement Collaborative to Improve Clinical Outcome in Patients with Acute Myocardial Infarction
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The quality of care for Swedish patients with acute myocardial infarction (AMI) is continuously increasing. Nevertheless, a great potential for improvement still exists.

The aim of the present study was to design and implement a systematic quality improvement (QI) collaborative in the area of AMI care, and to validate its usefulness primarily by analyzing its effect on hospital adherence to national guidelines. Also, the impact on patient morbidity and mortality was to be evaluated. The intervention was based on proven QI methodologies, as well as interactive use of a web-based quality registry with enhanced, powerful feedback functions.

19 hospitals in the intervention group were matched to 19 similar control hospitals. In comparison with the control group, the intervention group showed significantly higher post-interventional improvements in 4 out of 5 analyzed quality indicators (significance shown for ACE-inhibitors, Clopidogrel, Heparin/LMWH, Coronary angiography, no significance for Lipid-lowering therapy).

From baseline to the post-intervention measurement, the intervention hospitals showed significantly lower all-cause mortality and cardiovascular re-admission rates (events per 100 patient-years; -2,82, 95% CI -5,26 to -0,39; -9,31, 95% CI -15,48 to -3,14, respectively). No significant improvements were seen in the control group.

The improved guideline adherence rates in the intervention hospitals were sustained for all indicators but one (ACE-inhibitors), this during a follow-up measurement three months after study support withdrawal. No effects were seen on any indicators other than those primarily targeted.

In conclusion, by combining a systematic QI collaborative with the utilization of a national quality registry, significant improvements in quality of care for patients with AMI can be achieved.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 66 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 813
Quality Improvement, Quality Registry, Acute Coronary Care, Guideline Adherence
National Category
Cardiac and Cardiovascular Systems
Research subject
urn:nbn:se:uu:diva-180327 (URN)978-91-554-8470-5 (ISBN)
Public defence
2012-10-26, Enghoff salen, Uppsala University Hospital, Entrance 50, Uppsala, 13:00 (English)
Available from: 2012-10-04 Created: 2012-09-03 Last updated: 2013-01-23Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Åberg, ChristinaGarmo, HansLindahl, Bertil
By organisation
Department of Medical SciencesUCR-Uppsala Clinical Research Center
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 188 hits
ReferencesLink to record
Permanent link

Direct link