Changes Over Six Years in Administration of Aspirin and Beta Blockers on Arrival and Timely Reperfusion and in In-Hospital and 30-Day Postadmission Mortality in Patients With Acute Myocardial Infarction
| Autor: | Giovanni Filardo, David J. Ballard, David Nicewander |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Adrenergic beta-Antagonists Myocardial Infarction Marginal structural model Myocardial Reperfusion Internal medicine medicine Humans In patient Myocardial infarction Aged Quality of Health Care Aspirin Myocardial reperfusion business.industry Odds ratio medicine.disease Confidence interval Coronary heart disease Surgery Emergency medicine Cardiology Female Guideline Adherence Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | The American Journal of Cardiology. 107:1421-1425 |
| ISSN: | 0002-9149 |
| DOI: | 10.1016/j.amjcard.2011.01.017 |
| Popis: | There is conflicting evidence regarding the impact of improving quality-of-care measures on patient outcomes. From July 2002 through June 2008, compliance with 3 in-hospital acute myocardial infarction quality-of-care measures (administration of aspirin and β blockers on arrival, timely reperfusion) and mortality were assessed in consecutive patients eligible for ≥1 of the measures at 8 hospitals (n = 6,826). Adjusted odds ratios for in-hospital and 30-day postadmission mortality and rate ratios for compliance with the 3 quality-of-care measures were calculated using marginal structural models to assess differences over time. Compliance with the 3 in-hospital quality-of-care measures improved significantly over the 6-year period. Adjusted odds ratios (95% confidence intervals) revealed significant decreases in in-hospital mortality in cohorts eligible for aspirin at arrival (year 6 vs baseline 0.37, 0.22 to 0.65), β blockers at arrival (year 6 vs baseline 0.24, 0.11 to 0.52), and an "all-eligible" measure comprising aspirin at arrival, β blockers at arrival, and timely reperfusion (year 6 vs baseline 0.41, 0.24 to 0.69). Significant decreases in 30-day postadmission mortality followed the same pattern (aspirin at arrival 0.53, 0.35 to 0.80; β blockers at arrival 0.43, 0.26 to 0.73; all-eligible measure 0.54, 0.36 to 0.81). In conclusion, over the 6-year study period, the health care system's compliance with the 3 in-hospital quality-of-care measures and 30-day mortality improved significantly. |
| Databáze: | OpenAIRE |
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