Page 198 - HA Convention 2015

Service Priorities and Programmes Free Papers

SPP8.7 Young Hospital Authority Investigators Presentations 14:30 Room 221

Acute Myocardial Infarction (AMI) Clinical Pathway — Does It Save Lifes?
Wong KL1, Choi K 2, Chan P 2, Chan KKW 1, Lam SCC 1, Tam FCC 1, Wong AYT 1, Yung ASY 1, Chan EKY 1, Shea PC 1, Lam YM 1,
Lam L1, Chan RHW 1, Lee SWL1
1Department of Medicine, 2Clinical Audit Team, Queen Mary Hospital, Hong Kong

Introduction

Acute myocardial infarction (AMI) is associated with high mortality but compliance with evidence-based treatments is
suboptimal. Clinical pathway is a standardised protocol developed for the management of a specific disorder with an aim to
homogenise clinical practice complying with evidence-based treatments. The implementation of an AMI clinical pathway has
been shown to improve adherence to evidence-based AMI treatments, but whether this effect results in reduction in death
(case fatality) is unclear.

Objectives

(1) To demonstrate that implementation of AMI clinical pathway is associated with improvement in in-hospital, 30-day and six-
month case fatality rate; and (2) to demonstrate that implementation of AMI clinical pathway is associated with improvement
in 30-day and six-month survival.

Tuesday, 19 May Methodology

(1) AMI between 2004 and 2011 were categorised into two cohorts: before (2004 to 2007) and after (2007 to 2011) the
implementation of a clinical pathway. (2) The case fatality rate (CFR) was assessed by multivariate logistic regression, and
survival was assessed by Cox proportional hazards regression analyses.

Results

(1) 2,029 AMI, 859 before and 1,170 after the clinical pathway implementation were analysed. (2) The in-hospital CFRs for the
two cohorts were 14.6% and 10.9%, respectively – odds ratio (OR) 0.649 [CI 0.492-0.856], p=0.002). (3) The 30-day CFRs
were 18.4% and 14.9%, respectively – OR 0.672 [CI 0.521-0.868], p=0.002). (4) The six-month CFRs were 26.0% and 22.9%,
respectively - OR 0.700 [CI 0.555-0.881], p=0.002). (5) Cox regression models showed significant improvement in survival at
both 30 days (p=0.002) and six months (p=0.001) in the post-pathway cohort.

Conclusion
Implementation of AMI Clinical Pathway is associated with reduction in case fatality rates and improvement in survival.

HOSPITAL AUTHORITY CONVENTION 2015

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