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Acute Myocardial Infarction (AMI)

 

Acute Myocardial Infarction Indicators

Acute Myocardial Infarction (AMI), one of a subset of an Ischaemic Heart Disease (IHD), is the third leading cause of death in Singapore in 2016[1]. AMI better known as heart attack occurs when blood flow to the heart is blocked or reduced causing the heart tissue to die. Risk factors such as smoking, diabetes, elevated cholesterol, high blood pressure and obesity increases the risk of a heart attack.

Perfect Care Indicator

'Perfect Care' for AMI patient is an evidence-based treatment guideline introduced by McLeod Health that has been recognised by international health authorities in US and Australia. KTPH has incorporated the 'Perfect Care' guideline and has set it as one of our quality of care improvement initiatives. AMI patients are considered to have received ‘Perfect Care’ when they have received the following care elements, unless contra-indicated:

i)     Early administration of aspirin,
ii)    Aspirin at discharge,
iii)   Statin at discharge,
iv)   Beta blocker at discharge,
v)    Angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blockers (ARB) for left ventricular systolic dysfunction (LVSD) at discharge,
vi)   Timely administration of thrombolytics or percutaneous coronary intervention (PCI)
vii)  Smoking cessation counselling.

The average rate from January 2016 to March 2018 was 96.6%, which is higher than the 2016 National Benchmark of 95.6%.

Figure 1: Perfect Care for AMI by Department of Cardiology, KTPH
Figure 1: Perfect Care for AMI by Department of Cardiology, KTPH

 

Percutaneous Coronary Intervention within 90 Minutes of Hospital Arrival Indicator

Among the seven care elements in our Perfect Care Indicator, timely administration of Percutaneous Coronary Intervention (PCI) is closely monitored to ensure that time-critical treatment is delivered to AMI patients. PCI is a non-invasive procedure performed to open blocked coronary arteries and to restore blood flow to the heart tissues. A special catheter (small tube), with a tiny balloon at its tip, is inserted into the blocked artery. The balloon is inflated and compresses the fatty tissues blocking the artery, allowing a larger opening and thus improving the blood flow to the heart tissues.

This time-critical treatment is measured by the ‘door-to-balloon’ time. The internationally adopted gold standard as established by the American College of Cardiology and the American Heart Association for the ‘door-to-balloon’ time is 90 minutes or less[4].
The average rate from January 2016 to March 2018 is 96.6%, which is comparable to international rates (UK Myocardial Ischaemia National Audit Project (MINAP), 13th Annual Report, 2014 rate: 92.1%).

Figure 2: Percutaneous Coronary Intervention within 90 Minutes of Hospital Arrival by Department of Cardiology, KTPH
Figure 2: Percutaneous Coronary Intervention within 90 Minutes of Hospital Arrival by Department of Cardiology, KTPH

 

References:

1. Ministry of Health > Statistics > Singapore Health Facts > Principal Causes of Death 2016

2. Ministry of Health, Singapore, Public Hospital Performance Report 2017

3. American Heart Association: Recommendations for Criteria for STEMI Systems of Care, updated 2016

4. UK Myocardial Ischaemia National Audit Project (MINAP), 13th Annual Report, 2014

5. Moscucci, M and Eagle, K. A. (2006). Door-to-Balloon Time in Primary Precutaneous Coronary Intervention: Is the 90-Minute Gold Standard an Unreachable Chimara? Circulation, 113, 1048-1050. Doi:10.1161/CIRCULATIONAHA.105.606905