Acute Myocardial Infarction Cooperative Project Research conducted by North Dakota Health Care Review, Inc. Study Findings Graph 1 - Thrombolytic Administration in AMI Patients The percentage of eligible AMI patients receiving thrombolytic therapy has increased significantly from 28.25 percent to 44.28 percent. Eleven participating hospitals demonstrated improvement to a rate greater than 50 percent. Although there has been a significant increase in the use of thrombolytics, there is still variation among facilities, demonstrating continued room for improvement in this area. Graph 2 - Thrombolytic Administration by Age Groups Thrombolytics were administered more often to eligible AMI patients within all age groups, with a significant increase in the < 65 age group and the 75-79 age group. Of particular note is the increase in the rate of administration of thrombolytics in the 90+ age group from 0 percent to 40 percent, demonstrating a change in the extent to which age influences the decision for thrombolytic administration. Graph 3 - Thrombolytic Administration Related to Duration of Symptoms There is a significant increase in the use of thrombolytics in eligible patients regardless of the time elapsed from onset of symptoms. The increased use of thrombolytics in eligible patients with symptom onset greater than six hours indicates that physicians are recognizing the benefits of thrombolytic use beyond the previous six-hour threshold. Graph 4 - Thrombolytic Administration: Effect of Age and Time from Symptom Onset to Arrival This table illustrates the combined effect of age and time from symptom onset on thrombolytic use, and demonstrates that thrombolytic administration decreases as both age and time from symptom onset increases. The improvement demonstrated in this graph represents the overall increased use of thrombolytic regardless of age or duration of symptoms. Graph 5 - Thrombolytic Therapy: Time from Arrival at ER Remeasurement data demonstrates an increase in the number of AMI patients who received thrombolytics within one hour of presentation to the ER. This improvement has contributed to a significant decrease in the median time to administration of thrombolytics from 68 minutes to 55 minutes. Graph 6 - Administration of Beta Blockers Overall use of beta blockers in eligible AMI patients has significantly increased from 32.5 percent in the baseline analysis to 47.5 percent in the remeasurement data. This change reflects the increasing emphasis on using beta blockers in AMI patients. Beta blocker therapy appears to reduce (1) the magnitude of infarction and incidence of associated complications in subjects not receiving concomitant thrombolytic therapy and (2) the rate of reinfarction in patients receiving thrombolytic therapy.* *Ryan TJ, Anderson JL, Antman EM, et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction), J Am Coll Cardiol 1996;28:1328-438. Graph 7 - Time from Onset of Symptoms to Arrival in ER The interval between onset of symptoms and presentation to the ER has decreased only minimally, underscoring the need for educating the public on the importance of seeking immediate treatment when symptoms occur. The median time from onset of symptoms to arrival in the ER is 120 minutes. Graph 8 - Inpatient Aspirin Therapy The number of eligible AMI patients receiving aspirin during the hospital stay has improved significantly. Twelve hospitals achieved an aspirin administration rate of 100% in their eligible AMI patients. Graph 9 - Time from Arrival to Administration of Aspirin Significantly more patients are receiving aspirin within 30 minutes of presentation to the ER than previously. This improvement has resulted in a decrease in the median time to aspirin administration from 177 minutes to 35 minutes. Graph 10 - Discharge Orders for Aspirin A comparison of baseline and remeasurement data reveals there has been no significant change in the number of eligible patients who received discharge orders for aspirin. We are unable to tell from our analysis of the data if this reflects a lack of documentation or reflects under utilization of aspirin at discharge. Because it is an over-the-counter medication, providers may not be documenting the directive for aspirin in the discharge orders.   PROGRAM INFORMATION | PREVENTING HEART DISEASE | THE IMPACT OF EARLY TREATMENT | ORGANIZATIONS THAT CAN HELP | HEALTHY HEART MAIN PAGE   © 1998 Prairie Public Broadcasting, Inc.