Care Pathways for Acute Coronary Syndrome

A quality improvement research project

Cardiovascular diseases are the leading cause of death globally. In Europe, half of the acute myocardial infarctions hospitalizations are due to ST elevated myocardial Infarction (STEMI). Optimal treatment for STEMI has been published and disseminated through decades of (inter)national guidelines. Despite the availability of these guidelines, adherence to evidence on STEMI care varies greatly between hospitals, systems of care and time.

The Care Pathways for Acute Coronary Syndrome (CP4ACS) Quality Improvement Research Project was set up by the European Pathway Association to evaluate and improve the care process and the quality of care for adult patients with STEMI in 16 Belgian hospitals. The project started in May 2013 as a collaboration between the European Pathway Association, the Health Services Research Group of the Department of Public Health & Primary Care, KU Leuven and the Department of Cardiology of the University Hospitals Leuven. The 3-year project is funded by an unrestricted Grant from Astra Zeneca.

CP4ACS uses an interrupted time series design with one retrospective and two prospective measurements on quality of care (both on patient as hospital level). Providing feedback on the actual organization of the care process, informing the teams on the available evidence, enhancing the teamwork and using quality improvement strategies are used as a complex intervention in the participating hospitals. Variables were selected by a RAND modified Delphi method and cover under-, over- and misuse of care. Specific attention to STEMI process improvement will be on time intervals (i.e. door to balloon time) and life style changes (i.e. smoking cessation, nutritional advice and activity level).

ImageProf. dr. Peter Sinnaeve (Department of Cardiology, University Hospitals Leuven): “CP4ACS succeeded to set up a bottom – up research project which enables STEMI teams to improve quality of care by providing evidence, benchmarking and tailored quality improvement interventions. As such it prepares STEMI teams for public reporting.”

Dr. Kris Vanhaecht ( together with prof. dr. Peter Sinnaeve ( are the principal investigators of the CP4ACS project. The project builds on previous EPA research experience on care pathways for hip fracture and COPD.

Daan Aeyels ( or +32 475298377) is the dedicated research fellow and Phd student for the CP4ACS project.

Dr. Kris Vanhaecht, secretary general, E-P-A