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Critical Care

Open Access

Improving quality indicators for the treatment of acute myocardial infarction: impact of the disease-specific care certification

  • PG Melo de Barros e Silva1,
  • MY Okada1,
  • S Simoes1,
  • VA Fernandes1,
  • TA Macedo1,
  • DL Ramos1,
  • MJ Rodrigues1,
  • MC do Amaral Baruzzi1 and
  • V Furlan1
Critical Care201317(Suppl 3):P11

Published: 19 June 2013


Registries have shown that there still exists a large gap between what is recommended by evidence-based guidelines and what is actually offered to the patient in clinical practice. Monitoring quality indicators allows the identification of these gaps and, in consequence, enables specific interventions for improvement. In January 2012 began, in a Brazilian private hospital, the implementation of the Clinical Care Program (CCP) for acute myocardial infarction (AMI). The present study aims to evaluate the impact of the CCP in quality indicators for AMI including in-hospital mortality.


All patients with a confirmed diagnosis of AMI (with or without ST elevation), after signing consent, become part of the CCP, and all care would be managed by a dedicated nurse who mobilizes a multidisciplinary team, checking records, organizing and monitoring indicators. Four indicators that are part of the Joint Commission International Library of measures were monitored before and after the implementation of the program: administration of acetylsalicylic acid (ASA) in the first 24 hours; prescription of ASA, β-blockers and ACEI/ ARB at discharge, excluding patients with contraindications. In-hospital mortality was also assessed. A comparison of the year before (Group I - 2011) versus the year after (Group II - 2012) initiation of the CCP was made. Statistical analysis included the calculation of point estimates and 95% CIs. Comparison of categorical variables was performed by chi-square and a two-tailed significant P value.


During 2011 and 2012, a total of 776 patients had the diagnosis of AMI in our service (Table 1).
Table 1

Comparison between Groups I and II

AMI patients

Group I - 2011

(n= 352)

Group II - 2012

(n= 424)

P value

ASA in the first 24 hours

96% (94 to 98%)

100% (99 to 100%)


ASA at discharge

99% (97 to 100%)

100% (99 to 100%)


β-blocker at discharge

94% (92 to 96%)

99% (98 to 100%)


ACEI/ARB at discharge

95% (93 to 97%)

99% (98 to 100%)


In-hospital mortality

5.1% (3.2 to 8%)

2.6% (1.4 to 4.6%)


95% CI in parentheses. ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blockers.


After beginning the CCP for AMI, a significant improvement in quality indicators occurred. Reduction of hospital mortality had a P value near the threshold for statistical significance.



This project is funded by Hospital Totalcor and Amil Clinical Research.

Authors’ Affiliations

Hospital Totalcor, Cerqueira César, São Paulo, Brazil


© Melo de Barros e Silva et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.