At an ACC'02 press conference on March 19, Rajendra H. Mehta, MD, from the University of Michigan Medical Center, reported that improvements in adherence to key quality indicators such as aspirin and beta blocker administration at admittance and smoking cessation counseling at discharge were markedly higher in both women and Medicare patients when compared to men and non-Medicare patients. In general, there were improvements in quality indicator adherence for all four patient populations.

The study in Michigan is part of the American College of Cardiology Foundation’s (ACCF) Guidelines Applied in Practice (GAP) initiative. The initial results of the study were published on March 13 in the Journal of the American Medical Association (JAMA).

In the study, medical staff at 10 southeastern Michigan hospitals used a “tool kit”—including a pocket clinical practice guideline, standard order sets, and a critical pathway for nurses—to help them adhere to key quality indicators in the care of AMI patients. The results published in JAMA showed, for example, that before implementation of GAP in the hospitals, only 65 percent of heart attack patients received beta blockers within 24 hours of arriving at the hospital; afterward, that figure rose to 74 percent. Similarly, the percentage of patients receiving aspirin within 24 hours of admittance rose from 81 percent to 87 percent.

The analysis presented on Tuesday was particularly important, Dr. Mehta stressed, because “the quality of care of AMI in women and the elderly has been suboptimal.”

Early use of ACE inhibitors in non-Medicare patients in the study increased from 35 percent to 42.2 percent. In Medicare patients, however, early ACE inhibitor usage increased from 33.7 percent to 43.7 percent. Similar results with important quality indicators were seen across the board. With beta blocker administration at discharge, for example, there was an increase in male patients from 90.1 percent to 92.5 percent. In female patients, beta blocker usage at discharge was 85.7 percent before implementation of GAP and 93.9 percent afterwards.

Given the promising results of the study, Dr. Mehta encouraged hospitals to consider implementing a GAP program in their own facilities. More information about the ACCF-GAP program is available on the College’s Web site. The GAP tools for heart attack treatment may be downloaded at no cost from http://www.acc.org/gap/mi/ami_gap.htm.