ACS QUIK: Effect of an AMI Quality Improvement Toolkit in India

Implementation of a quality improvement toolkit may lead to improvements in in-hospital and discharge medications in patients with acute myocardial infarction (AMI), according to results of the ACS QUIK trial presented Nov. 14 at AHA 2017 in Anaheim, CA.

Mark D. Huffman, MD, FACC, et al., looked at 21,374 patients with AMI from 63 hospitals in India. Patients were randomized to usual care or intervention that included a quality improvement toolkit with audit and feedback, admission and discharge checklists, patient education materials, and linkage to emergency cardiovascular care and quality improvement training.

Results showed improvements in process measures, including in-hospital and discharge medications, and clinical outcomes, including a reduction in the primary outcome of the rate of death, recurrent heart attack, stroke, and major bleeding at 30 days from 6.4 percent to 5.3 percent.

However, the researchers note that there were several temporal changes during the study period that could potentially influence the results. "When we adjusted for these background temporal trends during the two years of the study, the absolute difference in clinical outcomes was no longer statistically significant," said Huffman. 

The researchers explain that they are "studying factors that influence implementation, maintenance, and effect of the intervention across sites to identify conditions when the intervention is most likely be to effective and sustained."

They add that moving forward, future interventions can be derived to test their effects in different locations, diseases and targets "for better, safer care in India and other low- and middle-income countries."

Keywords: AHA17, AHA Annual Scientific Sessions, Quality Improvement, Myocardial Infarction

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