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Continuous Quality Improvement: Adherence to Performance Measures - Implementation of Antiplatelet, Statin, Beta-Blocker and Angiotensin System Blockade Therapy Post Myocardial Infarction, Compliance with ACC/AHA Guidelines

Introduction: With improvements in diagnosis and management of acute myocardial infarction (MI) more patients suffering MI are surviving to discharge. Patients with known coronary heart disease are at high risk for recurrent MI, stroke, and death. Thus interventions aimed at secondary prevention are critically important. We assessed compliance with secondary prevention guidelines and describe a strategy for improvement that was recently implemented at our institution.

Methods: We performed a retrospective chart review of 737 consecutive patients who presented to our institution from 2008 to 2010. Data was collected on patient demographics, medications prescribed at the time of discharge, and contraindications to each of the following classes of medications: aspirin, statin, beta blockers, and angiotensin system antagonists.

Results: The average age was 62 years, 67% were male, 74.8% had hypertension, 61.9% had diabetes, 42% were tobacco users, and 59.3% had dyslipidemia. Aspirin was prescribed to 721 (99.4%) patients, 3 (0.4%) had a contraindication. Beta blockers were prescribed to 692 (95.5%) patients, 27 (3.7%) had a contraindication. Angiotensin system inhibitors were prescribed to 587 (81.0%) patients, 61 (8.4%) had a contraindication. A statin was prescribed to 698 (96.6%), 10 (1.3%) had a contraindication.

Discussion: Therapeutic lifestyle changes remain the mainstay for secondary prevention after MI. Several adjunctive medications have demonstrated survival benefit. Given the proven survival benefit, the American Heart Association/American College of Cardiology recommend all patients, in the absence of contraindications, receive these four classes of medications. Our hospital has instituted an electronic prompt that requires the discharging clinician to either order each of these medications or place an order stating the reason why the medication is not prescribed.

Conclusion: As we strive to deliver excellent health care we must strive for 100% compliance with these recommendations. An electronic prompt when discharging patients after a myocardial infarction will likely improve compliance.

Author(s): Sachin Kumar Amruthlal Jain , Timothy R Larsen , Mohammad Nasser , I. Sam Tandon , Shukri David

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