François Schiele1, Suleman Aktaa2, Xavier Rossello3,4,5, Ingo Ahrens6, Marc J Claeys7, Jean-Philippe Collet8,9, Keith A A Fox10, Chris P Gale2, Kurt Huber11, Zaza Iakobishvili12, Alan Keys13, Ekaterini Lambrinou14, Sergio Leonardi15, Maddalena Lettino16, Frederick A Masoudi17, Susanna Price18, Tom Quinn19, Eva Swahn20, Holger Thiele21, Adam Timmis22, Marco Tubaro23, Christiaan J M Vrints7,24, David Walker25, Hector Bueno5,26,27, Sigrun Halvorsen28, Tomas Jernberg29, Jarle Jortveit30, Mai Blöndal31, Borja Ibanez32, Christian Hassager33,34. 1. University Hospital Besancon, Boulevard Fleming, 25000 Besancon, France. 2. University of Leeds, Leeds, UK. 3. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain. 4. Cardiology Department, Hospital Universitari Son Espases & Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain. 5. CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain. 6. Cardiology and Medical Intensive Care, Augustinerinnen Hospital Cologne, Cologne, Germany. 7. Antwerp University Hospital, Antwerp, Belgium. 8. Sorbonne Université, ACTION Study Group, Paris, France. 9. INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France. 10. University and Royal Infirmary of Edinburgh, Edinburgh, UK. 11. 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Sigmund Freud University, Medical Faculty, Vienna, Austria. 12. Department of Community Cardiology, Clalit Health Services, Jaffa District, Tel Aviv, Israel. 13. Tonbridge, UK. 14. Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus. 15. University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy. 16. Cardio-Thoracic-Vascular Department, San Gerardo Hospital, Monza, Italy. 17. University of Colorado Anschutz Medical Campus, Aurora, CO, USA. 18. Royal Brompton & Harefield NHS Foundation Trust, Imperial College, London, UK. 19. Kingston University & St. George's, University of London, London, UK. 20. Linkoping University, Linkoping, Sweden. 21. Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany. 22. Barts Heart Centre and Queen Mary University London, London, UK. 23. San Filippo Neri Hospital, Rome, Italy. 24. University of Antwerp, Antwerp, Belgium. 25. East Sussex Healthcare NHS Trust, UK. 26. Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain. 27. Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain. 28. Department of Cardiology, Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway. 29. Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. 30. Department of Cardiology, Sørlandet Hospital Arendal, Arendal, Norway. 31. Department of Cardiology, Tartu University, Estonia. 32. Department of Cardiology, Hospital Fundación Jiménez Díaz, Madrid, Spain. 33. Department of Cardiology, Rigshospitalet, Copenhagen, Denmark. 34. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Abstract
AIMS: Quality indicators (QIs) are tools to improve the delivery of evidence-base medicine. In 2017, the European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC) developed a set of QIs for acute myocardial infarction (AMI), which have been evaluated at national and international levels and across different populations. However, an update of these QIs is needed in light of the accumulated experience and the changes in the supporting evidence. METHODS AND RESULTS: The ESC methodology for the QI development was used to update the 2017 ACVC QIs. We identified key domains of AMI care, conducted a literature review, developed a list of candidate QIs, and used a modified Delphi method to select the final set of indicators. The same seven domains of AMI care identified by the 2017 Study Group were retained for this update. For each domain, main and secondary QIs were developed reflecting the essential and complementary aspects of care, respectively. Overall, 26 QIs are proposed in this document, compared to 20 in the 2017 set. New QIs are proposed in this document (e.g. the centre use of high-sensitivity troponin), some were retained or modified (e.g. the in-hospital risk assessment), and others were retired in accordance with the changes in evidence [e.g. the proportion of patients with non-ST segment elevation myocardial infarction (NSTEMI) treated with fondaparinux] and the feasibility assessments (e.g. the proportion of patients with NSTEMI whom risk assessment is performed using the GRACE and CRUSADE risk scores). CONCLUSION: Updated QIs for the management of AMI were developed according to contemporary knowledge and accumulated experience. These QIs may be applied to evaluate and improve the quality of AMI care. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Quality indicators (QIs) are tools to improve the delivery of evidence-base medicine. In 2017, the European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC) developed a set of QIs for acute myocardial infarction (AMI), which have been evaluated at national and international levels and across different populations. However, an update of these QIs is needed in light of the accumulated experience and the changes in the supporting evidence. METHODS AND RESULTS: The ESC methodology for the QI development was used to update the 2017 ACVC QIs. We identified key domains of AMI care, conducted a literature review, developed a list of candidate QIs, and used a modified Delphi method to select the final set of indicators. The same seven domains of AMI care identified by the 2017 Study Group were retained for this update. For each domain, main and secondary QIs were developed reflecting the essential and complementary aspects of care, respectively. Overall, 26 QIs are proposed in this document, compared to 20 in the 2017 set. New QIs are proposed in this document (e.g. the centre use of high-sensitivity troponin), some were retained or modified (e.g. the in-hospital risk assessment), and others were retired in accordance with the changes in evidence [e.g. the proportion of patients with non-ST segment elevation myocardial infarction (NSTEMI) treated with fondaparinux] and the feasibility assessments (e.g. the proportion of patients with NSTEMI whom risk assessment is performed using the GRACE and CRUSADE risk scores). CONCLUSION: Updated QIs for the management of AMI were developed according to contemporary knowledge and accumulated experience. These QIs may be applied to evaluate and improve the quality of AMI care. Published on behalf of the European Society of Cardiology. All rights reserved.
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