Document Detail

Impact of a critical pathway on acute myocardial infarction quality indicators.
MedLine Citation:
PMID:  14998217     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVE: To determine the impact of a critical pathway on acute myocardial infarction (AMI) quality indicators. DESIGN: Retrospective chart review. SETTING: Large university hospital. PATIENTS: One hundred seventy-five patients who underwent primary percutaneous transluminal angioplasty for AMI (control group 89 patients, intervention group 86 patients). MEASUREMENTS AND MAIN RESULTS: The medical records of the control group (1998-1999) were reviewed for door-to-balloon (DtB) time (the time between the patient's arrival at the emergency department and the first balloon inflation during a percutaneous transluminal coronary angioplasty procedure). Drug therapy prescribed at hospital discharge (aspirin, beta-blocker, angiotensin-converting enzyme [ACE] inhibitor, and lipid-lowering therapy) was also reviewed. The data collected for the control group were compared with the intervention group data (2000-2001). The impact of the pathway was evaluated using the Wilcoxon rank sum test, odds ratios (ORs), and chi2 tests. The DtB time was significantly lower in the intervention group versus the control group (91.5 vs 108 min, p < 0.01), and fewer intervention patients exceeded the guidelines with a DtB time longer than 120 minutes (OR 0.38, p < 0.01). In addition, the intervention group was more likely than the control group to be prescribed an ACE inhibitor (OR 3.7, p < 0.01) or lipid-lowering therapy (OR 3.7, p = 0.02) at discharge. Aspirin and beta-blockers were not prescribed differently in the intervention versus control groups (aspirin 95.2% vs 96.2%, beta-blockers 93.5% vs 92.6%). CONCLUSION: These data suggest that in the current era of published treatment guidelines, implementation of a critical pathway can further improve AMI quality indicators and clinical care.
Megan B Bestul; Marianne McCollum; Kathleen A Stringer; Jeb Burchenal
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Pharmacotherapy     Volume:  24     ISSN:  0277-0008     ISO Abbreviation:  Pharmacotherapy     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-03-04     Completed Date:  2004-07-28     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8111305     Medline TA:  Pharmacotherapy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  173-8     Citation Subset:  IM    
University of Colorado Hospital, Department of Clinical Pharmacy, School of Pharmacy, University of Colorado Health Sciences Center, 80262, USA.
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MeSH Terms
Acute Disease
Adrenergic beta-Antagonists / therapeutic use
Angioplasty, Transluminal, Percutaneous Coronary
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Antilipemic Agents / therapeutic use
Aspirin / therapeutic use
Critical Pathways / standards*
Lipids / blood
Medical Records
Myocardial Infarction / diagnosis*,  therapy
Patient Compliance
Quality Indicators, Health Care*
Retrospective Studies
Time Factors
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Antilipemic Agents; 0/Lipids; 50-78-2/Aspirin

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