Quality of care in the treatment of acute myocardial infarction

Acute myocardial infarction (AMI) is a leading cause of hospitalization, death, and health care expense in the United States. Large-scale, multisite, well performed, randomized, controlled trials have demonstrated many beneficial therapeutic interventions for AMI, including aspirin, reperfusion therapy, β blockers, angiotensin-converting enzyme inhibitors, avoidance of calcium channel blockers for low ejection fraction, and smoking cessation. Despite this body of clinical evidence for therapies that decrease mortality and increase long-term survival, there is tremendous variability in the treatment of AMI in the United States. Appropriate management should reduce AMI mortality and morbidity. Measuring the quality of care provided to AMI patients in the United States provides an assessment of the difference between best care as defined by the American College of Cardiology/American Heart Association guidelines and actual care. Using this information provides insight into why and how AMI care differs. Understanding the differences is critical to improving patient outcomes.