The management of acute myocardial infarction in the cardiological intensive care units in Italy: the ‘BLITZ 4 Qualità’ campaign for performance measurement and quality improvement

Abstract

Aim: To assess and promote compliance of Italian cardiological intensive care units (CCUs) with evidence-based guidelines for the management of acute myocardial infarction (MI). Methods and results:The process of diagnosis and treatment of MI was prospectively evaluated in 163 CCUs by use of 30 indicators during two enrolment phases, each followed by a feedback of both local and general performance. Overall, 5854 patients with ST-segment elevation MI (STEMI) and 5852 with non-ST-segment elevation MI (NSTEMI) were consecutively enrolled. The target for each indicator was defined as compliance with the relevant recommendations in ≥90% of suitable patients and it was met for nine (30%) and 10 (33.3%) indicators in the first and second phases, respectively. Regardless of target, a significant improvement in compliance was observed in the second phase in 10 out of 30 indicators (33.3%). Use of pre-hospital ECG, expedite delivery of reperfusion therapy, dosage of antithrombotic drugs, and non-pharmacological implementation of secondary prevention were often off target. Similar in-hospital mortality was observed in phases I and II, both in patients with STEMI (4.0 vs. 4.2%, p=0.79) and NSTEMI (1.8 vs. 2.4%, p=0.11). Overall, 30-day mortality were 5.7% for patients with STEMI and 3.4% with NSTEMI. Conclusions: Performance indicators can accurately weigh the whole process of diagnosis and treatment of patients with MI and monitor the improvements in the quality of care. In our large population of consecutive patients, satisfactory 30-day outcomes were observed despite suboptimal adherence to guidelines for some indicators of recognised prognostic relevance.

Secondary prevention after acute myocardial infarction: Drug adherence, treatment goals, and predictors of health lifestyle habits. The BLITZ-4 Registry

“…12 After discharge, while 90% of the patients attended at least one cardiac visit during a six-month follow-up, only a few patients were enrolled into secondary prevention programmes, including smoking cessation interventions, or cardiac rehabilitation.…”

One‐Year Mortality in Elderly Adults with Non‐ST‐Elevation Acute Coronary Syndrome: Effect of Diabetic Status and Admission Hyperglycemia

“…Approximately 30% of individuals with NSTEACS admitted to hospitals in Europe, and in Italy, are classified as having diabetes mellitus based on clinical history. In the general population with NSTEACS, which has a mean age of 67 in clinical trials and 70 to 73 in clinical practice, diabetes mellitus is a well‐documented predictor of worse outcome.…”

Temporal trends in the epidemiology, management, and outcome of patients with cardiogenic shock complicating acute coronary syndromes

“…Five consecutive nationwide prospective registries designed by the Italian Hospital Cardiology Association (ANMCO) in ACS patients were conducted in Italy between 2001 and 2014: BLITZ in 2001, IN‐ACS Outcome (Italian Network on Acute Coronary Syndromes Outcome) in 2006–2007, BLITZ‐4 in 2009 and 2010, MANTRA (Management of patients with ACS in the real world practice in Italy: an outcome research study focused on the use of ANTithRombotic Agents) in 2009–2010, and EYESHOT (EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units) in 2013 and 2014 . All surveys were nationwide and included patients with ACS consecutively admitted alive to the participating CCUs during a pre‐specified period (a few weeks for the BLITZ and EYESHOT registries and 1 year for IN‐ACS Outcome and MANTRA) ( Table ).…”

“…All surveys were nationwide and included patients with ACS consecutively admitted alive to the participating CCUs during a pre‐specified period (a few weeks for the BLITZ and EYESHOT registries and 1 year for IN‐ACS Outcome and MANTRA) ( Table ). The methods used for each registry have been described previously . Briefly, their primary objectives were to evaluate the clinical characteristics, management, and outcomes of consecutive patients with ACS admitted to Italian CCUs, using a catchment broad enough to provide data representative of the entire country.…”

“…Data on baseline characteristics, including demographics, risk factors, and medical history, were collected as previously described . Information on the use of cardiac procedures, including coronary angiography, type and timing of revascularization therapy (if any), use of medications during hospitalization and at hospital discharge, and in‐hospital major clinical events were recorded.…”