Guideline-based standardized care is associated with substantially lower mortality in medicare patients with acute myocardial infarction : The American college of cardiology's guidelines applied in practice (GAP) projects in Michigan

• Published in: Journal of the American College of Cardiology Vol. 46; no. 7; pp. 1242 - 1248
• Main Authors: EAGLE, Kim A, MONTOYE, Cecelia K, ROYCHOUDHURY, Canopy, ELMA, Mary Anne C, MITCHELL, Kristi R, MEHTA, Rajendra H, RIBA, Arthur L, DEFRANCO, Anthony C, PARRISH, Robert, SKORCZ, Stephen, BAKER, Patricia L, FAUL, Jessica, JANI, Sandeep M, BENRONG CHEN
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Science 04.10.2005; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Coronary heart disease; Coronary vessels; Female; Heart; Heart attacks; Hospitals; Humans; Male; Medical sciences; Medicare; Mortality; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Practice Guidelines as Topic; United States; United States; North America; America; Michigan; Human; Myocardial infarction; Prognosis; American; Acute; Mortality; Cardiovascular disease; Myocardial disease; Epidemiology; Phlebology; Recommendation; Care; Association; Heart disease; Professional practice; Circulatory system; Cardiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2004.12.083

We sought to assess the impact of the American College of Cardiology's Guidelines Applied in Practice (GAP) project for acute myocardial infarction (AMI) care, encompassing 33 acute-care hospitals in southeastern Michigan, on rates of mortality in Medicare patients treated in Michigan. The GAP project increases the use of evidence-based therapies in patients with AMI. It is unknown whether GAP also can reduce the rate of mortality in patients with AMI. Using a before (n = 1,368) and after GAP implementation (n = 1,489) cohort study, 2,857 Medicare patients with AMI were studied to assess the influence of the GAP program on mortality. Multivariate models tested the independent impact of GAP after controlling for other conditions on in-hospital, 30-day, and one-year mortality. Average patient age was 76 years, 48% were women, and 16% represented non-white minorities. The rate of mortality decreased after GAP for each interval studied: hospital, 10.4% versus 13.6%; 30-day, 16.7% versus 21.6%; and one-year, 33.2% versus 38.3%; all p < 0.02. After multivariate adjustment, GAP correlated with a 21% to 26% reduction in mortality, particularly at 30 days (odds ratio of GAP to baseline 0.74; 95% confidence interval [CI] 0.59 to 0.94; p = 0.012) and one year (odds ratio 0.78; 95% CI 0.64 to 0.95; p = 0.013), particularly in the patients for whom a standard discharge tool was used (1-year mortality, odds ratio 0.53; 95% CI 0.36 to 0.76; p = 0.0006). Embedding AMI guidelines into practice was associated with improved 30-day and one-year mortality. This benefit is most marked when patients are cared for using standardized, evidence-based clinical care tools.