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

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)

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.