American College of Cardiology Acute Myocardial Infarction Guidelines Applied to Practice Study - ACC AMI GAP

Description:

The goal of the American College of Cardiology (ACC) Acute Myocardial Infarction (AMI) Guidelines Applied to Practice (GAP) study was to assess compliance and use of ACC AMI Guideline recommendations prior to and following monitoring of guideline use, and with the use of guideline tools.

Hypothesis:

Monitoring of guideline use and use of guideline tools will increase adherence to the ACC AMI guidelines.

Study Design

Study Design:

Patients Enrolled: 3,957
Mean Follow Up: 12 months
Mean Patient Age: Mean age 71.8 years
Female: 47

Exclusions:

Contraindication to the therapies studied (acetyl salicylic acid [ASA], beta-blocker, ACE inhibitors).

Drug/Procedures Used:

Pre- and post-measurement and implementation of improvement strategies were assessed at 33 Michigan hospitals. To encourage use of the guidelines, ACC AMI tools were used including standing orders, pocket guidelines, discharge contracts, patient information forms, and critical pathways to facilitate adherence to quality indicators.

Principal Findings:

Use of several early standard order therapies increased with remeasurement and/or post-tool implementation (all comparisons for baseline vs. remeasurement and baseline vs. post-tool implementation, respectively): aspirin, 85% versus 87% (p<0.05) and 91% (p<0.001); beta-blocker, 71% versus 73% (p=NS) and 76% (p<0.05); and low-density lipoprotein (LDL) management, 72% versus 73%(p=NS) and 81% (p<0.001).

Late standard therapies also increased with remeasurement and/or post-tool implementation: aspirin, 82% versus 90% (p<0.001) and 94% (p<0.001); beta-blocker, 84% versus 92% (p<0.001) and 93% (p<0.001); angiotensin-converting enzyme (ACE) inhibitor, 77% versus 81% and 85% (p<0.01); smoking cessation, 51% versus 68% (p<0.001) and 86% (p<0.001); LDL management, 73% versus 78% (p<0.05) and 87% (p<0.001); and diet counseling, 68% versus 74% (p<0.001) and 91% (p<0.001). In-hospital mortality was 11.9% at baseline and 9.1% at remeasurement.

Interpretation:

Implementation of the ACC AMI GAP was associated with improvements in quality of care for patients with AMI, as assessed by guideline recommendation adherence. Use of the GAP tools was associated with an even larger improvement in quality of care. Improvements were seen in both early and late standard therapies. Guideline adherence is varied, with disparities in what the guidelines recommend and actual practice patterns. Use of monitoring and guideline tools is important for improving quality of care, which could potentially result in improved outcomes.

References:

Presented at Late-Breaking Trials, ACC 2003.

Clinical Topics: Dyslipidemia, Prevention, Lipid Metabolism, Diet

Keywords: Michigan, Myocardial Infarction, Hospital Mortality, Counseling, Coronary Disease, Lipoproteins, LDL, Quality Indicators, Health Care, Guideline Adherence, Diet, Smoking Cessation


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