Trial DesignMISSION!: Optimization of acute and chronic care for patients with acute myocardial infarction
Section snippets
Study design
MISSION! is designed according to a quasi-experimental approach.14 The MISSION! protocol is developed based on the most recent American College of Cardiology/American Heart Association and European Society of Cardiology guidelines for AMI.2, 3 It contains a prehospital, inhospital, and outpatient clinical framework for decision making and treatment, up to 1 year after the index event (Figure 1). The MISSION! goals, addressing all aspects of AMI care, are summarized in Figure 2. The
Preliminary results
MISSION! is a multifaceted intervention. Figure 8 shows the timeline of implementation of the MISSION! protocol. The development of the MISSION! protocol started in October 2003. The first patients were enrolled in February 2004. Until now, 300 patients are included in the inhospital and outpatient MISSION! protocol. The communication between a limited number of ambulances and the PCI center started as a pilot in September 2004. Since January 2005, all ambulances are participating.
Baseline
Discussion
The treatment of patients with AMI has expanded and improved tremendously over the last 2 decades. However, widespread dissemination of EBM in daily practice is still lacking, and a significant number of patients with AMI is undertreated.4, 5, 6, 7, 8 Prior AMI guideline implementation programs succeeded to increase the uptake of guidelines in daily care.10, 11, 13 However, these programs mainly focus on inhospital AMI care, whereas it is known that the prehospital and chronic care for patients
Conclusions
MISSION! adds a new dimension in the field of AMI quality improvement initiatives, by integrating all AMI care phases in 1 structured patient-centered care program. The aim of MISSION! is to improve AMI care by implementing the most recent AMI guidelines across practical settings in real life. The preliminary results of MISSION! are promising. If this integrated approach of AMI care proves to work, MISSION! may function as a guideline implementation program beyond our region.
References (26)
- et al.
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
J Am Coll Cardiol
(2005) - et al.
Care of non–ST-segment elevation patients: insights from the CRUSADE national quality improvement initiative
Am Heart J
(2004) - et al.
Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP)
Am J Cardiol
(2001) - et al.
The prehospital electrocardiogram in acute myocardial infarction: is its full potential being realized? National Registry of Myocardial Infarction 2 Investigators
J Am Coll Cardiol
(1997) - et al.
Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour
Lancet
(1996) - et al.
International differences in evolution of early discharge after acute myocardial infarction
Lancet
(2004) - et al.
An organizational framework for the AMI ACC-GAP Project
J Am Coll Cardiol
(2005) - et al.
Changing the model of care for patients with acute coronary syndromes
Am Heart J
(2003) - et al.
The burden of cardiovascular diseases mortality in Europe. Task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe
Eur Heart J
(1997) - et al.
ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction)
Circulation
(2004)
Management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology
Eur Heart J
National and state trends in quality of care for acute myocardial infarction between 1994-1995 and 1998-1999: the Medicare health care quality improvement program
Arch Intern Med
Use of reperfusion therapy for acute myocardial infarction in the United States: data from the National Registry of Myocardial Infarction 2
Circulation
Cited by (0)
This study is supported financially by the Dutch Heart Foundation, The Netherlands Society of Cardiology, and an unrestricted research grant from Guidant.