Impact of a cardiac discharge order form on the use of proven-effective therapies in post myocardial infarction patients

Context

Despite clinical trial evidence and established treatment guidelines, there is current underusage of proven effective therapies in post acute myocardial infarction (AMI) patients.

Objectives

The purpose of this study was to assess the frequency and appropriateness of discharge drug therapy, and to assess the impact of a new cardiac discharge prescription order form on the use of proven effective therapies.

Setting

A 400 bed, acute care teaching institution.

Design

We conducted a retrospective chart review (from May 1, 1999 to July 31, 1999) to establish current discharge prescribing trends.  After the implementation of the cardiac form, we conducted another chart review (from January 1, 2000 to March 31, 2000) to observe the impact of the form on the frequency and appropriateness of use of these therapies. Patient demographics and specific information regarding a patient’s indication or contraindication for the following medication therapies were collected: ACE inhibitors, anticoagulants, antiplatelet drugs, beta-blockers, and lipid lowering agents.

Main Outcome Measures

The outcome measures were frequency and appropriateness of use of therapies for post acute myocardial infarction (AMI) patients.

Results

Pre-implementation period we reviewed 102 charts (92 evaluable) and post-implementation period reviewed 35 charts (33 evaluable). Observed a trend of stable or improved usage of proven effective therapies in eligible patients: ACE inhibitors 59% to 83%, anticoagulants 69% to 100%, antiplatelet drugs 98% to 100%, beta-blockers 97% to 94%, and lipid lowering agents 69% to 61%. When the cardiac form was used there was excellent use of proven effective therapies with 100% of eligible patients receiving the indicated therapy.

Conclusions

There was a trend towards an improved use of post AMI medications after implementation of a new cardiac discharge prescription form. When the new form is employed, use of proven effective therapies is optimized.

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