HeartBeat--improving heart attack care

We aimed to save lives by assuring best practice in ST elevation myocardial infarction (STEMI) through initiating the Institute for Healthcare Improvement (IHI) methodology nationally. Following collection of a minimum dataset, annual change in indicators in the five initiating hospitals for the period Oct 2006 - Sept 2009 was assessed by analysing the percentage of patients receiving the eight components of evidenced based care on admission and discharge and in-hospital mortality rate. For 635 patients, performance on seven of the eight indicators of care exceeded 90% annually. Timely reperfusion therapy (thrombolysis, primary percutaneous coronary intervention (PPCI)) improved non-significantly from 68.2% (107 patients) in year 1 to 77.1% (118 patients) in year 3. In-hospital mortality declined significantly from 12.4% (24 deaths) in year 1 to 5% (9 deaths) in year 3. Evidence based STEMI care is followed to a high degree but timely reperfusion and PPCI provision remain a challenge nationally.