The effect of acute coronary syndrome care pathways on in‐hospital patients: A systematic review

Abstract

BackgroundHealth care institutions need to construct management strategies for patients diagnosed with acute coronary syndrome (ACS) that focus on evidence‐based treatments, adherence to treatment guidelines, and organized care. These help to reduce variations as well as the mortality and morbidity rates, which indicates the critical need for standardized care and adherence to evidence‐based practices for patients hospitalized with ACS. The care pathways translate research and guidelines into clinical practice to close the gap between the guidelines and the clinical practices.ObjectivesThis review focuses on identifying the indicators used to evaluate ACS care pathways and their effect on the care process and clinical outcomes.MethodsThis review follows the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidelines. The systematic research was conducted using five research databases. Two groups were created by dividing the studies according to their year of publication. The first group included those studies published from 1997 to 2007 (“Group 1”), while the second included those published from 2008 to 2018 (“Group 2”). Selected studies were screened using the Effective Public Health Practice Project (EPHPP) quality assessment tool.ResultsSeventeen studies were included in this review. One study was a randomized controlled trial, 14 were predesigns and postdesigns, and two were longitudinal observational designs. The Group 1 studies demonstrated that ACS care pathways had a positive effect on reducing the length of the hospital stay and the door‐to‐balloon times. Similar effects were observed for the Group 2 studies.ConclusionImplementing ACS care pathway helps to organize care processes and decrease treatment delays as well as improve the patient outcomes without adverse consequences for patients or additional resources and costs. While the current level of evidence is inadequate to warrant a formal recommendation, there is a need for more studies with an emphasis on well‐designed randomization to measure patient outcomes.

Triglyceride-Glucose Index Predicts Adverse Events in Patients with Acute Coronary Syndrome: A Meta-Analysis of Cohort Studies

“…Acute coronary syndrome (ACS) is a category of clinically severe coronary artery disease (CAD) characterized by the acute rupture of vulnerable atherosclerotic plaques and subsequent total occlusion of the coronary arteries [1,2]. Clinically, ACS could be further classified as ST segment elevated myocardial infarction (STEMI) and non-ST segment elevated ACS (NSTE-ACS) [1].…”

Las “Vías Clínicas” como estrategia de mejoramiento en el manejo del Síndrome Coronario Agudo, una revisión narrativa.

“…En una revisión sistemática (11), cinco estudios evaluaron las tasas de mortalidad encontrándose resultados variables, donde dos de ellos mostraron una reducción de la tasa de mortalidad. El estudio de Pelliccia et al (13), reportó una reducción en el 8% (Mortalidad con implementación de la vía: 12%, sin implementación de la vía: 20%) en las tasas de mortalidad hospitalaria cuando se implementaron las vías de atención (P <0.05), mientras que Figura 1.…”

“…En una revisión sistemática que se centró en evaluar el efecto de las vías clínicas en el proceso de atención y resultados clínicos del síndrome coronario agudo, se encontraron dos estudios que mostraron una disminución de eventos coronarios significativos después la implementación de la vía clínica (13,25). Así mismo, otro estudio evaluó los síntomas de angina recurrente y las tasas de infarto de miocardio no fatal después de la implementación de la vía clínica y encontró una disminución significativa del 28.5% al 13% (P <0.02) y del 15% a 5% (P <0.03), respectivamente, después de la implementación de la vía clínica (11,26) Por otro lado, en un ensayo clínico multicéntrico realizado en siete hospitales de Nueva Zelanda, no se encontraron diferencias en las tasas de eventos cardiacos mayores (MACE) a 30 días, antes y después de la intervención entre las cohortes de pacientes. En la cohorte control, 5 de 962 (0.52%) presentaron un MACE a los 30 días, en comparación con 16 de 3,632 pacientes (0.44%) en la cohorte de intervención (27).…”

“…Aunque existe abundante literatura internacional sobre los beneficios de las vías clínicas en el manejo del síndrome coronario agudo, también hay resultados contradictorios y las revisiones sistemáticas plantean que la evidencia es insuficiente para establecer una recomendación formal de las "vías clínicas" como una estrategia que pueda constituirse en parte integral de una política pública en los diferentes sistemas de salud (8)(9)(10)(11). Por lo anterior, el objetivo de este estudio fue realizar una revisión de los resultados de las vías clínicas en el manejo del síndrome coronario agudo, debido a la complejidad de variables (biológicas, culturales, políticas, económicas, etc.)…”

Implementing a Care Pathway for Complex Chronic Patients from a Nursing Perspective: A Qualitative Study

“…The European Pathway Association defines the care pathway as a complex intervention for the mutual decision-making and organization of care processes for a well-defined group of patients during a well-defined period, although a variety of terms have been used interchangeably in the international literature without a clear differentiation, such as critical pathway, clinical pathway, integrated care pathway, or care map [ 5 , 6 ]. Different studies have highlighted the strengths of implementing the care pathway, revealing an overall positive impact on the organization, coordination, and monitoring of care processes, the involvement of professionals and the improvement of process indicators [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Health professionals play a decisive role in the implementation, development, and evaluation of chronic care strategies [ 14 , 15 ].…”