Trial Design
The Prospective Registry Evaluating Myocardial Infarction: Events and Recovery (PREMIER)—Evaluating the impact of myocardial infarction on patient outcomes

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Background

More information on the longitudinal care and outcomes of patients after myocardial infarction (MI) is needed to further improve the quality of MI care. The PREMIER study was designed to meet this need.

Methods

Patients with MI were prospectively screened and enrolled from 19 US centers between January 1, 2003, and June 28, 2004. Consenting patients had detailed chart abstractions of their medical history and processes of inpatient care, supplemented with a detailed, patient-centered interview. Centralized follow-up at 1, 6, and 12 months is being conducted to quantify patients' postdischarge care and outcomes, with a focus on their health status (symptoms, function, and quality of life). In 2003, detailed chart abstractions, devoid of all personal health information, were collected for patients eligible but not enrolled in PREMIER.

Results

Of 10 911 patients screened, 3953 were eligible and 2498 enrolled into PREMIER. Few clinically significant differences between the total MI population and those enrolled into PREMIER were observed. Adherence to accepted processes of quality care, such as aspirin and β-blockers on admission (96% and 91%) or discharge (96% and 93%), was high. One-month follow-up rates were high, with only 9% of patients being lost to follow-up.

Conclusion

PREMIER is a novel registry with detailed insights into patients' sociodemographic, clinical, and health status characteristics, as well as detailed monitoring of their inpatient and outpatient processes of care. Ultimately, PREMIER will describe patients' health status outcomes and identify determinants of these outcomes as an important step toward improving MI care.

Section snippets

Background

A number of prospective registries in patients with MI have been conducted. Among the first major US initiatives was the National Institutes of Health–sponsored Worcester Heart Attack study, which examined the epidemiology, inpatient care, and inhospital outcomes of residents of Worcester Massachusetts from 1975 through 2001.10 This was followed by a series of 4 NRMI registries, sponsored by Genentech, beginning in 1990.11 These initiatives have included >1600 hospitals throughout the United

Overview of the PREMIER registry

The primary goal of PREMIER was to provide a rich understanding of patients' health status (their symptoms, function, and quality of life) 1 year after MI. As a prototypical example, we sought to describe the prevalence of angina in the current treatment era to understand the determinants of persistent angina and to understand the consequences of angina on patients' functioning, treatment satisfaction, return to work, and quality of life. The insights garnered from such investigations could

Results

The PREMIER registry began on January 1, 2003, and ended on June 28, 2004. The quality improvement portion of the study ended on January 1, 2004. Enrolling patients required, on average, approximately 4 hours each (∼15 minutes for screening, ∼2 hours of chart abstraction, ∼45 minutes for interviews, ∼45 minutes of data entry, and ∼15 minutes of a cardiologist's time to interpret electrocardiograms and angiograms). Two centers (Swedish Medical Center and Baptist Health) terminated the study

Discussion

The Institute of Medicine has challenged the medical profession to realize its full potential by creating an American health care system that is safe, timely, efficient, equitable, evidence-based, and patient-centered.27 Realizing this latter goal of patient-centered care requires understanding patients' perspectives of their disease, the ways in which their health status is limited by symptoms and functional limitations, and how these factors impair their quality of life. PREMIER is a unique

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    This study was principally supported by CV Therapeutics, Inc, Palo Alto, CA, and R-01 HS11282-01 from the Agency for Healthcare Research and Quality, Rockville, MD. This study was also supported by a Veterans Affairs Health Services Research Advanced Research Career Development Award (ARCD-98-341-2) (Dr Rumsfeld), Washington, DC.

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