How to measure quality of care in patients presenting with STEMI? A single-centre experience

Abstract

Objective The evaluation of the quality of care delivered to patients with acute coronary syndromes is becoming increasingly important. Due to novel regulations permitting the installation of new catheterization laboratories in Belgium, the Flemish government initiated a project to measure quality of care in patients with an ST-elevated myocardial infarction (STEMI) by measuring four quality indicators: prescription of ACE inhibitor, beta blocker or aspirin on discharge and unadjusted mortality. However, we are not convinced that these four indicators will provide suffi cient information on the quality of care in our hospitals. Hence, we performed a retrospective analysis on a larger set of parameters and evaluated their applicability as indicators of quality of care.Methods We measured 38 indicators in 153 patients (69 transferred and 84 on-site) with a STEMI who presented at, or were transferred to the UZ Brussels in 2013 and received percutaneous coronary intervention (PCI).Results The unadjusted overall mortality was 7.2% (n =11/153). Important diff erences in unadjusted mortality were observed between the on-site and transferred patients (10.7%, n = 9 vs 2.9%, n = 2, P = 0.112), which were attributed to the initial condition at presentation and a larger proportion of cardiogenic shocks in the on-site group. Discharge medication highly corresponded with the ESC guidelines.Conclusion We demonstrate that the proposed quality indicators do not provide suffi cient information to compare hospitals and that it is of utmost importance to weigh the mortality according to risk profi le.