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- Bellman, Christina, et al.
(författare)
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Achievement of secondary preventive goals after acute myocardial infarction : a comparison between participants and nonparticipants in a routine patient education program in Sweden
- 2009
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Ingår i: Journal of Cardiovascular Nursing. - 0889-4655 .- 1550-5049. ; 24:5, s. 362-368
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Modification of risk factors such as smoking, obesity, physical inactivity, and hypertension after acute myocardial infarction (AMI) has been shown to reduce mortality and morbidity. Therefore, most hospitals in Sweden invite patients with myocardial infarction to an educational program, the "Heart School," where they can learn about lifestyle changes. Whether this kind of education program applied in routine care increases the proportion of patients achieving secondary prevention goals is unknown. METHODS: A cohort of consecutive patients treated for AMI and included in a quality registry was followed up during 1 year. The main aim was to study the effects of taking part in the Heart School on smoking habits, blood pressure and low-density lipoprotein cholesterol levels, exercise habits, cardiac symptoms, quality of life, and readmissions to hospital. Patients included in the national quality register of secondary prevention after AMI who had participated in the educational program were compared with those who had not participated in the program. Achievements of secondary prevention goals 1 year after the myocardial infarction were evaluated. The study included 2,822 patients. RESULTS: The result showed that patients who participated in the Heart School stopped smoking more often than those who did not participate (adjusted odds ratio, 2.01; 95% confidence interval, 1.46-2.78). The Heart School had no effects on the other variables that were examined. CONCLUSION: The interventions currently used in the Swedish Heart School seem to be insufficient to obtain sustainable lifestyle changes, except for smoking cessation.
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| 2. |
- Carlhed, Rickard, et al.
(författare)
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Quality improvement in coronary care : Analysis of sustainability and impact on adjacent clinical measures after a Swedish controlled, multicenter quality improvement collaborative
- 2012
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Ingår i: Journal of the American Heart Association. - 2047-9980. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background Quality Improvement in Coronary Care, a Swedish multicenter, controlled quality-improvement (QI) collaborative, has shown significant improvements in adherence to national guidelines for acute myocardial infarction, as well as improved clinical outcome. The objectives of this report were to describe the sustainability of the improvements after withdrawal of study support and a consolidation period of 3 months and to report whether improvements were disseminated to treatments and diagnostic procedures other than those primarily targeted.Methods and Results Multidisciplinary teams from 19 Swedish hospitals were educated in basic QI methodologies. Another 19 matched hospitals were included as blinded controls. All evaluations were made on the hospital level, and data were obtained from a national quality registry, Swedish Register of Information and Knowledge About Swedish Heart Intensive Care Admissions (RIKS-HIA). Sustainability indicators consisted of use of angiotensin-converting enzyme inhibitors, lipid-lowering therapy, clopidogrel, low-molecular weight heparin, and coronary angiography. Dissemination indicators were use of echocardiography, stress tests, and reperfusion therapy; time delays; and length of stay. At the reevaluation period of 6 months, the improvements at the QI intervention hospitals were sustained in all indicators but 1 (angiotensin-converting enzyme inhibitor). Between the 2 measurements, the control group improved significantly in all but 1 indicator (angiotensin-converting enzyme inhibitor). However, at the second measurement, the absolute adherence rates of the intervention hospitals were still numerically higher in all 5 indicators, and significantly so in 1 (clopidogrel). No significant changes were observed for the dissemination indicators.Conclusions The combination of a systematic QI collaborative with a national, interactive quality registry might lead to substantial and sustained improvements in the quality of acute myocardial infarction care. However, to achieve disseminated improvements in adjacent clinical measures, those adjacent measures probably should be made explicit before any QI intervention.
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