Implementing clinical guidelines on acute myocardial infarction care in an emergency service

The implementation of clinical guidelines on acute myocardial infarction (AMI) care produces better results.

To present a multidisciplinary program to implement these guidelines in a large public emergency center and check its impact.

Evaluation study on health services, with "before and after" type design, to assess the indicators of quality of AMI care before and after implementation of training strategies and to facilitate emergency teams' acceptance of clinical guidelines. This includes the development of educational and awareness-raising materials and continued supervision. Relative risk estimate (RR) and confidence intervals (95%).

Pre-program group, 78 cases of AMI; post-program group, 66 cases of AMI. Most cases were treated only in the emergency room, due to small number of vacancies in the coronary care unit. We observed a significant increase (p<0.05) in the use of various interventions evaluated (process indicators): beta-blockers, 83%; angiotensin-converting enzyme inhibitors, 22%; lipid-lowering agents, 69%; intravenous nitrate, 55%; coronary reperfusion in acute myocardial infarction with ST-segment elevation, 98%. The use of aspirin from the first day of the IAM reached 95.5% of cases. The loss of opportunity of coronary reperfusion in patients with this indication, reduced from 71.4% to 17.6% post-training.

The program achieved a significant impact and its propagation to other units may contribute to better assist IAM in the public health system.