Efeito da implementação de um protocolo assistencial de infarto agudo do miocárdio sobre os indicadores de qualidade

Makdisse, Márcia; Katz, Marcelo; Corrêa, Alessandra da Graça; Forlenza, Luciano Monte Alegre; Perin, Marco Antônio; Júnior, Fábio Sândoli de Brito; Nascimento, Teresa Cristina Dias Cunha; Gomes, Ivanise; Franken, Marcelo; Knobel, Marcos; Pesaro, Antônio Eduardo Pereira; Santos, Oscar Fernando Pavão dos; Neto, Miguel Cendoroglo; Lottenberg, Claudio Luiz

doi:10.1590/s1679-45082013000300016

Cited by 10 publications

(10 citation statements)

References 14 publications

(15 reference statements)

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“…AMI was defined according to international guideline criteria [ 10 ]: typical rise and gradual fall of biochemical markers of myocardial necrosis (troponin or creatine kinase-MB) with at least one of the following: 1) ischemic symptoms, 2) development of pathologic Q waves on the electrocardiogram (ECG), 3) ECG changes indicative of ischemia (ST-segment elevation or depression), or 4) coronary artery intervention (e.g., coronary angioplasty). The registry design, methods, and main results have been reported previously [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

Mechanical Ventilation and Clinical Outcomes in Patients with Acute Myocardial Infarction: A Retrospective Observational Study

Pesaro

Katz

et al. 2016

PLoS ONE

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PurposePatients with acute myocardial infarction (AMI) and respiratory impairment may be treated with either invasive or non-invasive mechanical ventilation (MV). However, there has been little testing of non-invasive MV in the setting of AMI. Our objective was to evaluate the incidence and associated clinical outcomes of patients with AMI who were treated with non-invasive or invasive MV.MethodsThis was a retrospective observational study in which consecutive patients with AMI (n = 1610) were enrolled. The association between exclusively non-invasive MV, invasive MV and outcomes was assessed by multivariable models.ResultsMechanical ventilation was used in 293 patients (54% invasive and 46% exclusively non-invasive). In-hospital mortality rates for patients without MV, with exclusively non-invasive MV, and with invasive MV were 4.0%, 8.8%, and 39.5%, respectively (P<0.001). The median lengths of hospital stay were 6 (5.8–6.2), 13 (11.2–4.7), and 28 (18.0–37.9) days, respectively (P<0.001). Exclusively non-invasive MV was not associated with in-hospital death (adjusted HR = 0.90, 95% CI 0.40–1.99, P = 0.79). Invasive MV was strongly associated with a higher risk of in-hospital death (adjusted HR = 3.07, 95% CI 1.79–5.26, P<0.001).ConclusionsIn AMI setting, 18% of the patients required MV. Almost half of these patients were treated with exclusively non-invasive strategies with a favorable prognosis, while patients who needed to be treated invasively had a three-fold increase in the risk of death. Future prospective randomized trials are needed to compare the effectiveness of invasive and non-invasive MV for the initial approach of respiratory failure in AMI patients.

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Section: Methodsmentioning

confidence: 99%

Mechanical Ventilation and Clinical Outcomes in Patients with Acute Myocardial Infarction: A Retrospective Observational Study

Pesaro

Katz

et al. 2016

PLoS ONE

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“…Considerando que os protocolos médico-assistenciais são planos diagnósticos e terapêuticos para serem cumpridos, como instrumentos transparentes de avaliação, comunicação, orçamento, e, importantes ferramentas no processo da visualização da qualidade assistencial, servindo não só para antecipar os custos, assim como para evidenciar a eficácia dos resultados, nos estudos, observa-se que a construção e implementação dos protocolos médico-assistenciais, pode ser uma importante estratégia tática e operacional no ciclo do cuidado multiprofissional 5,29,30 . Assim, os protocolos médico-assistenciais são formas "do que fazer e como fazer" em determinadas situações, são best practices que todos os hospitais/ instituições de saúde deveriam buscar para obter uma qualidade mandatória 5,29,30 .…”

Section: Discussionunclassified

“…Assim, os protocolos médico-assistenciais são formas "do que fazer e como fazer" em determinadas situações, são best practices que todos os hospitais/ instituições de saúde deveriam buscar para obter uma qualidade mandatória 5,29,30 . Nos estudos selecionados, ainda não se observa a existência de referências do uso de protocolos assistenciais utilizados como elemento de qualidade nas auditorias das atividades multiprofissionais institucionais, e consequentemente, como uma ferramenta importante na melhoria de glosas.…”

Section: Discussionunclassified

Glosas hospitalares e o uso de protocolos assistenciais: revisão integrativa da literatura

Silva¹,

Hinrichsen²

2017

RAS

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“…The registry design, the methods and the principal results have been reported previously [14]. AMI was defined according to the criteria described in international guidelines [15]: a typical rise and gradual fall (troponin) or a more rapid rise and fall (muscle and brain creatine kinase) of biochemical markers of myocardial necrosis, with at least 1 of the following parameters: (a) ischemic symptoms; (b) the development of pathologic Q waves on the electrocardiogram; (c) electrocardiogram changes indicative of ischemia (i.e.…”

Section: Methodsmentioning

confidence: 99%

Prognostic Value of Serial Brain Natriuretic Peptide Measurements in Patients with Acute Myocardial Infarction

Pesaro

Katz²,

Caixeta³

et al. 2015

Cardiology

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Objectives: Elevated B-type natriuretic peptide (BNP) levels following acute myocardial infarction (AMI) are associated with adverse outcomes. The role of serial BNP monitoring after AMI has been poorly investigated. We aimed to evaluate the prognostic value of in-hospital serial BNP measurements in AMI patients. Methods: Patients with AMI (n = 1,924) were retrospectively evaluated. We selected patients with at least 2 in-hospital BNP measurements. The association between in-hospital mortality and BNP measurements (earliest, highest follow-up and the variation between measurements) were tested in multivariate models. Results: Serial BNP levels were determined in 176 patients. Compared to the rest of the population, these patients were older and had higher mortality rates. In the adjusted models, only the highest follow-up BNP remained associated with in-hospital death (odds ratio 1.06; 95% confidence interval, CI, 1.01-1.15; p = 0.014). Receiver-operating characteristic curve analysis demonstrated that the highest follow-up BNP was the best predictor of in-hospital death (area under the curve = 0.75; 95% CI 0.64-0.86). Conclusions: Serial BNP monitoring was performed in a high-risk subgroup of AMI patients. The highest follow-up BNP was a better predictor of short-term death than the baseline and in-hospital variation values. In AMI patients, a later in-hospital BNP assessment may be more useful than an early measurement.

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Efeito da implementação de um protocolo assistencial de infarto agudo do miocárdio sobre os indicadores de qualidade

Cited by 10 publications

References 14 publications

Mechanical Ventilation and Clinical Outcomes in Patients with Acute Myocardial Infarction: A Retrospective Observational Study

Mechanical Ventilation and Clinical Outcomes in Patients with Acute Myocardial Infarction: A Retrospective Observational Study

Glosas hospitalares e o uso de protocolos assistenciais: revisão integrativa da literatura

Prognostic Value of Serial Brain Natriuretic Peptide Measurements in Patients with Acute Myocardial Infarction

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