A new performance indicator for acute myocardial infarction

Area of Science:

• Cardiology
• Healthcare Quality Improvement
• Public Health

Background:

• Acute myocardial infarction (AMI) management requires robust performance indicators to assess treatment efficacy.
• Current outcome measures like case fatality may be influenced by diagnostic variations.
• There is a need for a reliable, auditable outcome measure for AMI care.

Purpose of the Study:

• To develop and evaluate a performance indicator for acute myocardial infarction (AMI).
• To assess the feasibility of using 'lives saved per 1000 patients treated' as an alternative to case fatality.
• To measure the performance of ambulance services and hospitals in managing AMI and cardiac arrest.

Main Methods:

• A two-year audit of AMI and out-of-hospital cardiac arrest cases in patients under 75.
• Separate auditing of patient response times, ambulance service performance, and hospital resuscitation/thrombolytic treatments.
• Comparison of hospital case fatality rates with the proposed 'lives saved/1000 patients treated' metric.

Main Results:

• Overall, 83 lives were saved per 1000 patients treated (95% CI 70-96).
• Out-of-hospital and in-hospital resuscitation accounted for 35% and 46% of lives saved, respectively.
• Thrombolytic treatment was estimated to have saved 19% of lives; no significant differences in case fatality were observed between hospitals.

Conclusions:

• 'Lives saved per 1000 patients treated' is an easily measurable index for assessing healthcare performance.
• This indicator effectively evaluates both ambulance services and hospital care quality.
• Its robustness to diagnostic variations makes it a potentially superior alternative to case fatality for performance auditing.