Improving Cardiovascular Outcomes through Systems Approach to Evidence Based Care. Les Barnette, MD Medical Director, Healthcare Improvement. Evidence Review . 30,000 foot overview over the cardiovascular literature jungle Looking for major landmarks . Goals.
Les Barnette, MD
Medical Director, Healthcare Improvement
Early Use of Beta Blockers to Evidence Based Care
WA State 67%
Nat’l median 64%
Nat’l range 33-80%
Beta Blockers at Discharge
WA State 66%
Nat’l median 72%
Nat’l range 47-93%Beta Blocker Use in MI
“Primary PTCA appears to be superior to thrombolytic therapy... with the proviso that success rates for PTCA are as good as those achieved in the trials”
DeWood MA, et al.Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. NEJM. 1980; 303: 897-902.
ACC/AHA Practice Guidelines. Guidelines for the Management of Patients with Acute Myocardial Infarction. JACC 1996; 28:1328-1428 JACC 1999; 34; 891-911.
Antiplatelet Trialist’s Collaboration. Collaborative overview of randomized trials of antiplatelet therapy. M\BMJ 1994,308: 81-106.
The MIAMI Trial Research Group. Metoprolol in Acute Mycardial Infarction: patient population. Am J Card. 1985; 56: 1G-57G.
ISIS-2 (Second International Infarct Survival) Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both or neither among 17,187 cases of suspected myocardial infarction. ISIS-2. Lancet 1988,2: 349-360.
The TIMI Study Group. Comparison of invasive and conservation strategies after treatment with tissue plasminogen activator in acute myocardial infarction: result of the thrombolysis in myocardial (TIMI) phase II trial. NEJM. 1989.320: 618-627Selected References--Myocardial Infarction II
Ferguson J. Meeting Highlights. Highlights of the 71st Scientific Session of the American Heart Association(news) Circulation 1999, 99: 2486-2491. (STENT-PAMI)
Pfeffer, MA et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. NEJM 1992;327:669-77
Thank You Mycardial Infarction: patient population. Am J Card. 1985; 56: 1G-57G.