2020 Update of the quality indicators for acute myocardial infarction: a position paper of the Association for Acute Cardiovascular Care: the study group for quality indicators from the ACVC and the NSTE-ACS guideline group

Abstract

Aims Quality indicators (QIs) are tools to improve the delivery of evidence-base medicine. In 2017, the European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC) developed a set of QIs for acute myocardial infarction (AMI), which have been evaluated at national and international levels and across different populations. However, an update of these QIs is needed in light of the accumulated experience and the changes in the supporting evidence. Methods and results The ESC methodology for the QI development was used to update the 2017 ACVC QIs. We identified key domains of AMI care, conducted a literature review, developed a list of candidate QIs, and used a modified Delphi method to select the final set of indicators. The same seven domains of AMI care identified by the 2017 Study Group were retained for this update. For each domain, main and secondary QIs were developed reflecting the essential and complementary aspects of care, respectively. Overall, 26 QIs are proposed in this document, compared to 20 in the 2017 set. New QIs are proposed in this document (e.g. the centre use of high-sensitivity troponin), some were retained or modified (e.g. the in-hospital risk assessment), and others were retired in accordance with the changes in evidence [e.g. the proportion of patients with non-ST segment elevation myocardial infarction (NSTEMI) treated with fondaparinux] and the feasibility assessments (e.g. the proportion of patients with NSTEMI whom risk assessment is performed using the GRACE and CRUSADE risk scores). Conclusion Updated QIs for the management of AMI were developed according to contemporary knowledge and accumulated experience. These QIs may be applied to evaluate and improve the quality of AMI care.

Quality of acute myocardial infarction care in England and Wales during the COVID-19 pandemic: linked nationwide cohort study

“…The eligibility criteria for each QI was determined according to the specifications provided in the ESC ACVC document. 14 …”

“…Quality indicators (QIs) have been increasingly used as a mechanism to measure broad aspects of care, 9 identify unwanted variation 10 11 and drive quality improvement. 12 For AMI, a suite of QIs exist which are valid, 13 internationally recognised 14 and have built on earlier indicators that have an inverse association with mortality. [15][16][17][18][19] We used the UK national cardiovascular registries to investigate the quality of AMI care according to these indicators during the first national lockdown in the COVID-19 pandemic.…”

European Society of Cardiology Quality Indicators for the care and outcomes of cardiac pacing: developed by the Working Group for Cardiac Pacing Quality Indicators in collaboration with the European Heart Rhythm Association of the European Society of Cardiology

“…8 While a few individual indicators for cardiac devices have been developed by the Centres for Medicare and Medicaid Services, 9–11 we are not aware of any published set of QIs for cardiac pacing. This is in contrast to sets of QIs by the ESC, 12 , 13 and other professional societies. 14 , 15 Therefore, the ESC established the Working Group for cardiac pacing QIs to work on the development of indicators of care quality for cardiac pacing in collaboration with the European Heart Rhythm Association (EHRA) and in parallel with the writing of the 2021 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy.…”

“…In this document, we provide a suite of seven main and four secondary QIs that transcend four patient journey domains and may be used in the evaluation of cardiac pacing care and outcomes. The QIs were developed though a standardized methodology, 16 which has been used for the development of feasible and valid QIs for other cardiovascular conditions, 12 and as a joint effort between the Task Force of the 2021 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy, EHRA, the ESC Patient Forum, and international experts in cardiac devices under the remit of the ESC Clinical Practice Guideline Quality Indicator Committee. The participation of stakeholders from 13 countries, including patients, and the co-development of these QIs with the 2021 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy, have enabled the provision of specific, measurable, and relevant QIs for cardiac pacing care.…”

“…For structural QIs, only numerator definitions were provided because these are binary (yes, no) measurements. 12 …”