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  • Use of Evidence-Based Therapy at Discharge

myocardial infarction


Over the past 20 years, treatment of acute myocardial infarction has improved through more rapid recognition of symptoms, treatment with fibrin-specific thrombolytics and percutaneous coronary intervention, and clinical trials that have demonstrated reductions in morbidity and mortality with appropriate acute treatment and secondary prevention. Specifically, evidence now supports the use of acetylsalicylic acid (ASA), adrenergic fi-receptor antagonists (fi-blockers), angiotensin-converting enzyme inhibitors (ACE inhibitors), and 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) for eligible patients who have experienced acute myocardial infarction. This information has led to the publication of guidelines outlining optimal treatments for patients with acute myocardial infarction.1,2 From these guidelines, processes of care have been developed to ensure that patients receive evidence-based care that will improve outcomes.

Before 2003, published reports from the United States and Canada indicated that the use of these medications remained suboptimal. To improve the use of proven therapies and to ensure that care for patients with acute myocardial infarction reflected the standards of the Canadian health care system, the Canadian Cardiovascular Outcomes Research Team/Canadian Cardiovascular Society (CCORT/CCS) devel­oped a set of quality indicators. The benchmark or minimum target levels set for the medications listed above, in terms of prescription rate at discharge for “ideal” patients (those without contraindications to the therapy), were at least 90% for ASA, at least 85% for fi-blockers, at least 85% for ACE inhibitors, and at least 70% for statins.

Canadian institutions providing care to patients with acute myocardial infarction were encouraged to evaluate their care processes using these benchmarks. Other Canadian initiatives, such as Safer Healthcare Now!, have supported these goals. With the publication of these initiatives, there was interest in evaluating the level of care at the authors’ institution. Eastern Health is the largest health authority in Newfoundland and Labrador, providing tertiary care to a population of over 290 000 people and specialized cardiac services for the entire provincial population (more than 500 000 individuals). Cialis Jelly

The objective of this study was to determine the propor­tion of patients discharged from 2 tertiary care sites of Eastern Health with a diagnosis of acute myocardial infarction who had a discharge prescription for ASA, fi-blocker, ACE inhibitor, or statin and to compare these results with the national benchmarks.

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