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Royal Sussex County
Hospital, Cardiac Research Department, 1 Abbey Road, Brighton, East
Sussex BN2 1ES, UK
Correspondence to: Dr Norris robin.norris{at}talk21.com
Accepted 8 November
2000
OBJECTIVE
To develop a performance
indicator for acute myocardial infarction which would reliably measure
success of treatment and which might provide an alternative to case
fatality as an audited outcome.
DESIGNA two year audit of all cases
of acute myocardial infarction and resuscitated cases of out of
hospital cardiac arrest from coronary heart disease in patients under
75 years of age. Behaviour of patients in calling for help, performance
of the ambulance services in treating out of hospital arrest, and of
the hospitals in providing resuscitation and thrombolytic treatment are
audited separately.
SETTINGFour district general hospitals.
AUDITED INTERVENTIONSResuscitation
from cardiac arrest and thrombolytic treatment.
MAIN OUTCOME MEASURESHospital case
fatality and lives saved/1000 patients treated.
RESULTSOverall, the lives of 83/1000
patients were saved (95% confidence interval 70 to 96). Of these, 29 (35%) were saved by out of hospital resuscitation and 38 (46%) by in
hospital resuscitation from cardiac arrest. It was estimated that 16 lives (19%) were saved by thrombolytic treatment. There were no
significant differences in case fatality among the hospitals.
CONCLUSIONSLives saved/1000 patients
treated is an easily measurable index and assesses performance of the
ambulance service as well as of the hospital. Because it is relatively
insensitive to diagnostic definitions, it may provide a robust
alternative to case fatality as a performance indicator.
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