CAN PRACTICE PATTERNS AND OUTCOMES BE SUCCESSFULLY ALTERED - EXAMPLESFROM CARDIOVASCULAR MEDICINE

OBJECTIVE: To offer an attributive opinion of recent improvements in a cute myocardial infarction (AMI) practice patterns and patient outcome s in the culture of an active research program. DATA SOURCES: Review o f original clinical data from five sequential, consecutively enrolled, AMI patient cohorts and University of Alberta Hospitals from 1987-93. DATA SYNTHESIS: Early cohorts had low use of trial-proven efficacious therapies for AMI, particularly among high risk older and female pati ents. Over time, there were continuous and marked increases in the use of efficacious therapies and decreased use of nonefficacious therapie s, with a paralled decrease in mortality among high risk patients. CON CLUSIONS: In a large tertiary care hospital between 1987 and 1993 the use of evidence-based AMI therapy and survival in high risk patients s ignificantly increased. The continuity and large size of these improve ments in AMI practice patterns, compared with similar populations repo rted in the contemporary literature, suggest it is unlikely they were due to chance. Rather, intercurrent reported measurement and reporting of key health care performance indicators, and initiation of explicit critical path AMI practice guidelines provide a more likely explanati on. Future studies by a network of community and university investigat ors will test whether findings are true for a broad AMI population and whether similar practice definition and improvement tools are effecti ve for other cardiac problems, including the management of congestive heart failure.