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(BETHESDA,
MD)—Following evidence-based practice guidelines and
standardized treatment protocols can help improve the quality
of care of patients being treated for a heart attack, according
to the one-year results of a study
published in the March 13 Journal of the American Medical
Association (JAMA).
Under
the auspices of the American College of Cardiology Foundation's
(ACCF) Guidelines Applied in Practice, or GAP, initiative,
medical staff at 10 southeastern Michigan hospitals used a
"tool kit" to help support their efforts to provide high-quality
care for patients who had been admitted with an acute myocardial
infarction, or heart attack. The results of the program were
impressive. Before implementation of the ACCF-GAP program,
for instance, 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, and the percent
of patients who were prescribed aspirin on discharge from
the hospital rose from 82 percent to 92 percent. These changes
mean fewer people will die from their heart disease.
"The
GAP project provided for greater consistency of care regardless
of age or gender, and closed the gap of care that existed
for the elderly and female patients in several areas of care,"
said Kim Eagle, MD, the principal investigator for the ACCF-GAP
initiative. "For patients, this means an improved quality
of care while they are in the hospital and improved outcomes
after discharge."
Use
of beta-blockers in patients admitted for a heart attack,
for example, has been shown to reduce the risk of death one
year after discharge by 20-25 percent. Similarly, use of aspirin
in heart attack patients at admission and at discharge can
reduce the risk of future heart attacks by a similar percentage.
Smoking-cessation counseling, which improved from 53 percent
to 65 percent, is particularly important because studies have
shown that quitting smoking can reduce the risk of a second
heart attack and heart disease-related death by 50 percent
or more.
The
GAP Tool Kit includes:
- a
pocket guideline-an easy-to-use, condensed version of the
ACC/American Heart Association (AHA) Practice Guidelines
for the Management of Patients With Acute Myocardial Infarction;
-
standard order sets, which serve as a trigger for physicians
to make decisions about proven therapeutic measures in heart
attack patients and that allow them to easily order and
document appropriate care;
-
a "critical pathway" for nurses, which helps them track
patients through the normally expected course of events
during hospitalization; and
- materials
for patients to use after they leave the hospital that remind
them about the importance of taking their medications, improving
their diet, and other activities aimed at preventing future
cardiovascular events.
"The
tool kit helps ensure that the doctor, nurse, and patient
are all in agreement on the key priorities of care from admission
to discharge and beyond," Dr. Eagle explained. "When there
is a system to remind all three of the key targets for care
throughout the patient's stay, the level of adherence to these
priorities improves and patients get better care."
The
basis for several components of the GAP Tool Kit is the ACC/AHA
practice guidelines for heart attack care—one of the
17 ACC/AHA practice guidelines developed by the top experts
in cardiovascular medicine.
"The
College has developed and published clinical practice guidelines
for cardiovascular care for more than 15 years. These guidelines
are intended to improve the effectiveness of care, optimize
patient outcomes, and reduce the overall cost of care," said
Raymond Gibbons, MD, chair of the ACCF committee overseeing
the College's GAP program. "However, these benefits do not
always occur, as guidelines are not always followed in every
day clinical practice. The landmark results of the ACCF-GAP
project show that it is possible to improve the use of guidelines
and thereby improve the quality of care."
Because
of its success in Michigan, Dr. Gibbons noted, the ACCF-GAP
initiative is already being expanded to other areas of cardiovascular
disease care, including the launch of similar GAP studies
aimed at improving the treatment of heart failure in physician
practices in Oregon and the treatment of stable angina (chest
pain) in physician practices in Alabama.
In
addition to being published in JAMA, results of the
GAP initiative in Michigan, focusing on women and the elderly,
will be presented at a news conference at the ACC 2002 Scientific
Session in Atlanta on March 19 at 11:30 a.m.
More
information about the ACCF-GAP program is available on the
ACC 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.
The
GAP Project was a partnership of the ACCF, the Michigan Peer
Review Organization, and the Greater Detroit Area Health Council,
which included an unrestricted research grant from Pfizer
Inc.
The
American College of Cardiology, a 28,000-member nonprofit
professional medical society and teaching institution, is
dedicated to fostering optimal cardiovascular care and disease
prevention through professional education, promotion of research,
leadership in development of standards and guidelines, and
the formulation of health care policy.
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