Abstract
Background: The most recent published guidelines regarding management of patients surviving an acute myocardial infarction (AMI) advocate the administration of aspirin (ASA), beta blockers (BB), and angiotensin‐converting enzyme inhibitors (ACEi) and discourages the use of calcium‐channel blockers (CCB). Previous data collected in our region from the National Registry (NR) showed a dismal compliance with these guidelines. In an attempt to increase physician awareness and to optimize implementation of recommended guidelines, a cardiac and pharmacy steering committee was created.
Methods: The pharmacist assigned to the project identified all patients admitted with an AMI using troponin‐I and creatine kinase‐MB (CK‐MB) reports. The pharmacist then contacted physicians to make recommendations if an adjunctive medication was not prescribed for a patient with no apparent contraindications. Administration rates for ASA, BB, ACEi, and CCB were then assessed and compared with the previously obtained baseline data from the NR.
Results: At admission, the use of ASA increased from 70 to 72%, BB from 45 to 72%, and ACEi from 12 to 44%. In terms of medications at discharge, ASA use increased from 74 to 88%. BB from 55 to 76%, and ACEi from 30 to 40%. In addition, the prescription rates for CCB at discharge decreased from 36 to 21%.
Conclusions: An interdisciplinary approach for disease management is an effective method for improving adherence to treatment guidelines simply with pharmacy intervention. the percentage of patients receiving the recommended adjunctive medications increased significantly. We propose that these guidelines should be periodically inserviced to physicians. Furthermore, patient counseling sessions should also be instituted to help reinforce the importance of compliance with the medications after discharge, as well as lipid management and smoking cessation.
Keywords: acute myocardial infarction, angiotensin‐converting enzyme inhibitors, aspirin, beta blockers, treatment guidelines, pharmacist
Full Text
The Full Text of this article is available as a PDF (475.2 KB).
References
- 1. Ryan TJ, Anderson JL, Amman EM, Braniff BA, Brooks NH, Califf RM, Hillis LD, Hiratzka LF, Rapaport E., Riegel BJ, Russell RO, Smith EE Jr., Weaver WD, ACC/AHA guidelines for the management of patients with acute myocardial infarction. J Am Coll Cardiol 1996: 28 (5): 1328–1428 [DOI] [PubMed] [Google Scholar]
- 2. Hennekens CH, Albert CM, Godfried SL, Gaziano JM, Buring JE: Adjunctive drug therapy of acute myocardial infarction. Evidence from clinical trials. N Engl J Med 1996: 335 (22): 1660–1667 [DOI] [PubMed] [Google Scholar]
- 3. Freemantle N., Cleland J., Young P., Mason J., Harrison J., Beta blockade after myocardial infarction: Systematic review and meta regression analysis. Br Med J 1999; 318: 1730–1737 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Maggioni AP, Latini R., How to use ACE‐inhibitors, beta‐blockers. and newer therapies in AMI. Am Heart J 1999; 138: 183–187 [DOI] [PubMed] [Google Scholar]
- 5. Chrysant SG, Vascular remodeling: The role of angiotensin‐converting enzyme inhibitors. Am Heart J 1998: 135: S21–30 [DOI] [PubMed] [Google Scholar]
- 6. Abernethy DR, Schwartz, JB , Drug therapy: Calcium‐antagonist drugs. N Engl J Med 1999; 341: 1447–1457 [DOI] [PubMed] [Google Scholar]
- 7. O'Connor GT, Quinton HB, Traven ND, Ramunno LD, Dodds TA, Marciniak TA, Wennberg JE, Geographic variation in the treatment of acute myocardial infarction. The Cooperative Cardiovascular Project. J Am Med Assoc 1991: 281: 627–633 [DOI] [PubMed] [Google Scholar]
- 8. Singh P., López‐Candales A., Suboptimal use of adjunctive pharmacologic strategies in survivors of an acute myocardial infarction: A survey from the western New York Region. J Invest Med 1998: 46: 290A [Google Scholar]
- 9. Ayanian JZ, Hauptman PJ, Guadagnoli E., Antman EM, Pashos CL, McNeil BJ, Knowledge and practices of generalist and specialist physicians regarding drug therapy for acute myocardial infarction. N Engl J Med 1994; 331: 1136–1142 [DOI] [PubMed] [Google Scholar]
- 10. Bello D., Shah NB, Edep ME, Tateo IM, Massie BM, Self‐reported differences between cardiologists and heart failure specialists in the management of chronic heart failure. Am Heart J 1999; 138: 100–107 [DOI] [PubMed] [Google Scholar]
- 11. Kizer JR, Cannon CP, McCabe CH, Mueller HS, Schweiger MJ, Davis VG, Perritt R., Antman EM, Trends in the use of pharmacotherapies for acute myocardial infarction among physicians who design and/or implement randomized trials versus physicians in routine clinical practice: The MILIS‐TIMI experience. Multicenter Investigation on Limitation of Infarct Size. Thrombolysis in Myocardial Infarction. Am Heart J 1999: 137: 79–92 [DOI] [PubMed] [Google Scholar]
- 12. Brand DA, Newcomber LN, Freiburger A., Tian H., Cardiologists' practices compared with practice guidelines: Use of beta‐blockade after acute myocardial infarction. J Am Coll Cardiol 1995; 26: 1432–1436 [DOI] [PubMed] [Google Scholar]
- 13. McLaughlin TJ, Soumerai SB, Willison DJ, Gurwitz JH, Borhas C., Guadagnoli E., McLaughlin B., Morris N., Cheng SC, Hauptman PJ, Antman E., Casey L., Asinger R., Gobel F., Adherence to national guidelines for drug treatment of suspected acute myocardial infarction: Evidence for undertreatment in women and the elderly. Arch Intern Med 1996; 156: 799–805 [PubMed] [Google Scholar]
- 14. Lee TH, Pearson SD, Johnson PA, Garcia TB, Weisberg MC, Guadagnoli E., Cook EF, Goldman L., Failure of information as an intervention to modify clinical management. A time‐series trial in patients with acute chest pain. Ann Intern Med 1995; 122: 434–437 [DOI] [PubMed] [Google Scholar]
- 15. Sarasin FP, Maschiangelo ML, Schaller MD, Heliot C., Mischler S., Gaspoz JM, Successful implementation of guidelines for encouraging the use of beta blockers in patients after acute myocardial infarction. Am J Med 1999: 106: 499–505 [DOI] [PubMed] [Google Scholar]