CONGRESS ABSTRACT

Background: Assessing the quality of care is the first step for improving the management of patients with acute myocardial infarction (AMI). The European Society of Cardiology (ESC) and the Acute Cardiovascular Care Association (ACCA) recently defined a set of quality indicators (QIs) of care for AMI patients. Aim: To assess the trend over time of quality of care for AMI patients admitted to the Cardiology ward of our first level hospital, using the ESC ACCA QI. Methods: QiC project is a prospective quality improvement study in real-world practice on all AMI patients admitted to our ward over a period of two and a half years with six-monthly audit activities. Case record forms were filled in by ward doctors during patient’s admission. Thirty-day mortality was assessed by examining the registry database of the Lombardy region. The ESC ACCA QIs set includes 17 main and 7 secondary QIs on centre organization, reperfusion and invasive strategies, risk assessment, antithrombotic treatment, secondary prevention discharge treatments, patient experience and outcomes. For each QI the percentage of attainment during the first and second semester of the study was assessed and compared by a chi-square test. Results: A total of 397 hospital admissions for AMI occurred in the first year from 1.5.23 to 30.4.24 (five patients were admitted twice and one patient four times). No patients denied consent, nine died during hospitalization, and 36 had to be urgently transferred to another hospital. The percentages of attainment for each QI in the 352 admissions for AMI ended with discharge to home or to a rehabilitation centre (157 in the first semester and 195 in the second semester) are reported in the Figure (first semester data in dark green and second semester data in light green; main QIs in bold). Improvement can be observed for some QIs in the second semester, even though the only statistically significant difference is for the reported duration of the dual antiplatelet therapy (DAPT) in the discharge letter (from 77% to 87%, p=0.02). Conclusions: The quality of care for acute myocardial infarction can be measured prospectively in the patients admitted to our Cardiology Department using the ESC ACCA set of quality indicators. First semester data show that the majority of quality indicators are met in our patients even if there is a large room for improvement. In the second semester, after the first audit activities, improvements can be observed for some QIs.