Acute Myocardial Infarction Cooperative Project A Health Care Quality Improvement Project Research and Findings conducted by North Dakota Health Care Review, Inc. Background In 1994, North Dakota Health Care Review, Inc., in cooperation with 37 of North Dakota's rural hospitals, implemented the Acute Myocardial Infarction Project. This project was designed to evaluate and improve the appropriate and timely use of thrombolytics and aspirin in the treatment of acute myocardial infarctions (heart attacks) in rural North Dakota hospitals. Why Thrombolytics And Aspirin? When treating a heart attack, every minute counts. Early intervention means that heart muscle damage is minimized and the potential for a patient's recovery is maximized. Thrombolytics and aspirin are considered optimal treatment approaches in rural hospitals where more invasive treatment methods are not available. The Project Analysis of hospital admissions for acute myocardial infarctions during 1993 revealed room for improvement in the areas selected for evaluation. For the past two years, NDHCRI has been working with individual rural hospitals to improve AMI treatment processes. Following this process improvement activity, hospital records for a portion of 1995 and 1996 AMI admissions were evaluated. The following information provides a look at the improvements that have been made. Measurement Parameters Case Selection All AMI cases from participating hospitals All hospital settings, including emergency room (ER), outpatient department, and acute care Exclusions AMI diagnosis NOT made on admission Patients who died in the emergency room, not allowing time for implementing treatment Contraindications to thrombolytics. Some patients are not eligible for thrombolytic therapy. Patients with the listed contraindications were not included in the study population. Absolute Contraindications (Existing Documented Contraindications) Current gastrointestinal/internal bleeding Surgery or significant trauma in the past 2 weeks Recent central nervous system structural damage (e.g., tumor, injury) Suspected aortic dissection Patient has "do not resuscitate" orders Patient preference Family preference Relative Contraindications (Physician Stated Contraindications) Abnormal prothrombin time, International Normalized Ratio, or platelet count Active ulcer disease History of cerebral vascular accident History of cerebral vascular accident (stroke, transient ischemic attack) Hemorrhagic eye condition History of bleeding disorder Cardio Pulmonary Resuscitation performed within past 24 hours Warfarin/Coumadin therapy at admission Uncontrolled hypertension (systolic blood pressure >200 or diastolic blood pressure >120) Click here for study findings   PROGRAM INFORMATION | PREVENTING HEART DISEASE | THE IMPACT OF EARLY TREATMENT | ORGANIZATIONS THAT CAN HELP | HEALTHY HEART MAIN PAGE Produced by Prairie Public Broadcasting, Inc.