Monitoring the quality of care in patients with acute myocardial infarction complicated by acute heart failure by using data from electronic medical records Experience from an underdeveloped country network

Background. Several improvements in performance measures (PM) have been described in Cuba in patients with ST-elevation myocardial infarction (STEMI). However, it is still unclear whether the reported improvement influences the treatment of STEMI complicated by acute heart failure. The aim of this study is to determine whether these changes in the renewed protocol have improved the MD of care of this specific subgroup. Materials and Methods. Patient data collection after June 2014 is mandatory in a web-based tool, which allows real-time follow-up of selected MDs. After a first stage, a protocol update was drafted, focusing on several aspects of poor compliance. The first stage closed with 81 patients admitted for heart failure after STEMI while the other 126 patients were included until the end of December 2019. MD data were obtained from all registries except those related to coronary intervention. Results. Improved management was observed for 6 MDs presented. Pharmacological treatments were administered to high standards, but no increase in in-hospital mortality was observed (21% vs. 24.6%; p=0.54). Although not significant, thrombolytics increased out-of-hospital prevalence (12/46 vs 26/72; p=0.256). Conclusion. Performance measures were improved after an update in the care protocols. However, the most important ones remained unchanged. Efforts should be made to maintain this increase in MD.