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Performance indicators in acute myocardial infarction: a proposal for the future assessment of good quality care

Many interventions employed in the management of patients with acute coronary syndromes (ACS) have been proved to be beneficial through well-designed clinical trials. Practice guidelines describe these interventions and the level of evidence supporting their use.1 Notwithstanding concerns related to the “generalisability” of trial data to clinical practice, a consensus on what is “good practice” is achievable. Yet comparisons between hospitals have disclosed significant variations in the care provided,2 3 and in risk-adjusted outcome.4 5 The description and quantification of the various facets of care is predicated on the belief that the efficient performance of these tasks leads to better outcomes. So measurement of the performance of such interventions is an indication of “good care”, and these aspects of care become “performance indicators”.

Existing performance indicators for acute myocardial infarction in England and Wales were derived from the National Service Framework for Coronary Heart Disease (NSF for CHD)6 and have been collected through the Myocardial Infarction National Audit Project (MINAP). An annual report identifies each participating hospital and expresses its success or failure with respect to the official indicator (box 1) and the prescription of drugs for the prevention of subsequent cardiovascular events. 

#### Box 1 Example of composite performance indicators: thrombolysis

For those with a final diagnosis of ST-elevation myocardial infarction a composite of 60 minute “call-to-needle time” and 30 minute “door-to-needle” time.

“Call-to-needle” is …