Volume 11 Supplement 3

Fourth International Symposium on Intensive Care and Emergency Medicine for Latin America

Open Access

Increase in prescription rate of angiotensin-converting enzyme inhibitors or angiotensin receptor blocker for hospitalized patients with acute myocardial infarction and left ventricular systolic dysfunction

  • MRP Makdisse1,
  • AG Correa1,
  • M Knobel1,
  • S Lagudis1,
  • F Bacal1,
  • SS Morhy1,
  • CH Fischer1,
  • MLC Vieira1,
  • EBL Filho1,
  • PKO Yokota1 and
  • E Knobel1
Critical Care200711(Suppl 3):P43

https://doi.org/10.1186/cc5830

Published: 19 June 2007

Introduction and objective

The rate of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (ACEi/ARB) at discharge is a quality indicator for acute myocardial infarction (AMI) care. The aim of the study was to evaluate changes in drug prescription before and after the implementation of a managed AMI protocol in patients hospitalized for AMI with moderate to severe left ventricular systolic dysfunction (LVSD).

Patients and methods

A total of 578 consecutive AMI patients (mean age: 68.0 ± 14.4 years) were evaluated. Of these, 92 were eligible for ACEi/ARB therapy at discharge (had LVEF <40% and/or narrative of LVSD and/or did not have a contraindication to ACEi/ARB and had survived their hospital stay without transfer to another facility). The managed AMI protocol was implemented in a tertiary hospital on 1 March 2005. Quality indicators were prospectively followed by a nurse case-manager, and periodic performance feedback (reports) were given to local hospital managers and clinical staff. Patients were divided into three groups: G1, pre-protocol (March 2004–February 2005); G2, first year post-protocol (March 2005–February 2006); and G3, second year post-protocol (March 2006–February 2007). Statistical analysis was performed using the chi-square test and Fisher's exact test. P < 0.05 was considered statistically significant.

Results

The results are presented in Table 1.
Table 1

(abstract P43)

Group

n

% ACEi/ARB prescription

P

G1, n = 15

8/15

53.3

0.03 (G1 × G2)

G2, n = 31

26/31

83.8

0.0004 (G1 × G3)

G3, n = 46

44/46

95.6

0.05 (G2 × G3)

Conclusion

A significant increase in the rate of ACEi/ARB prescription was observed both in the first and the second years after AMI protocol implementation. A trend toward an increase was also observed when the first and second years post-protocol are compared. These data suggest that managed protocols that include continuous monitoring of quality indicators are useful tools for implementing scientific evidence into clinical practice.

Authors’ Affiliations

(1)
Hospital Israelita Albert Einstein

Copyright

© BioMed Central Ltd 2007

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