Evaluation of the implementation of a local treatment guideline in secondary prevention post-myocardial infarction

Abstract

Objective: to validate and implement an audit tool to assess quality and appropriateness of prescribing. To compare in‐patient prescribing of secondary prevention in post myocardial infarction patients before and after introduction of a local treatment guideline.

Method: descriptive, non‐experimental retrospective case note review comparing patients treated before and after the implementation of a clinical guideline.

Main outcome: comparison of quality of prescribing in two patient groups

Results: Analysis of Group1 patients showed that 41% required treatment with an angiotensin converting enzyme inhibitor (ACE‐I), and 23% of those did not receive treatment, 20% of patients on ACE‐I received sub‐therapeutic doses. Seventy‐two per cent of patients required treatment with a statin and 22% of those did not receive a statin. Comparison of the treatment of Group 2 showed that, of 53 patients (50% of Group 2) requiring an ACE‐I, 100% received it, although 15% received sub‐therapeutic doses. Of 69 patients (64% of Group 2) requiring treatment with a statin 96% were prescribed a statin. Improvements in prescribing of b‐Blockers, ACE‐I and statins were statistically significant.

Conclusions: Prescribing improved significantly for b‐Blockers, ACE‐I and statins after guideline introduction with anticipated benefits to patient outcomes.