Elsevier

American Heart Journal

Volume 153, Issue 1, January 2007, Pages 14.e1-14.e11
American Heart Journal

Trial Design
MISSION!: Optimization of acute and chronic care for patients with acute myocardial infarction

https://doi.org/10.1016/j.ahj.2006.10.002Get rights and content

Background

Guideline implementation programs for patients with acute myocardial infarction (AMI) enhance adherence to evidence-based medicine (EBM) and improve clinical outcome. Although undertreatment of patients with AMI is well recognized in both acute and chronic phases of care, most implementation programs focus on acute and secondary prevention strategies during the index hospitalization phase only.

Hypothesis

Implementation of an all-phase integrated AMI care program maximizes EBM in daily practice and improves the care for patients with AMI.

Aim

The objective of this study is to assess the effects of the MISSION! program on adherence to EBM for patients with AMI by the use of performance indicators.

Design

The MISSION! protocol is based on the most recent American College of Cardiology/American Heart Association and European Society of Cardiology guidelines for patients with AMI. It contains a prehospital, inhospital, and outpatient clinical framework for decision making and treatment, up to 1 year after the index event. MISSION! concentrates on rapid AMI diagnosis and early reperfusion, followed by active lifestyle improvement and structured medical therapy. Because MISSION! covers both acute and chronic AMI phase, this design implies an intensive multidisciplinary collaboration among all regional health care providers.

Conclusion

Continuum of care for patients with AMI is warranted to take full advantage of EBM in day-to-day practice. This manuscript describes the rationale, design, and preliminary results of MISSION!, an all-phase integrated AMI care program.

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.

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  • 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.

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