[Monitoring of quality indicators of prescriptions after acute myocardial infarction]
P Aznarte Padial1, S Perez Vicente, A Zarzuelo Zurita
1Servicio de Farmacia, Hospital Virgen de las Nieves, Granada, España. mariap.aznarte.sspa@juntadeandalucia.es
Insights
This study found high adherence to quality standards for ST-segment elevation myocardial infarction management in Andalusia. Physician prescribing habits for angiotensin-converting enzyme inhibitors (ACEI) and sublingual nitroglycerin varied significantly, impacting quality adherence.
Area of Science:
- Cardiology
- Clinical Pharmacy
- Health Services Research
Context:
- Cardiovascular diseases represent a leading global cause of mortality.
- Established guidelines exist for managing acute coronary syndromes, including ST-segment elevation myocardial infarction (STEMI).
- Assessing adherence to regional quality standards is crucial for optimizing patient care.
Purpose:
- To evaluate the adherence to established quality standards for STEMI management in Andalusia.
- To identify variability in physician prescription patterns for STEMI patients.
- To analyze the sources of prescription variability among physicians.
Summary:
- An observational study analyzed 287 STEMI patient discharge reports from August 2005 to July 2007.
- High prescription rates were observed for antiplatelets (99.3%), acetylsalicylic acid (95.8%), beta-blockers (89.5%), and statins (84.6%).
- Angiotensin-converting enzyme inhibitors (ACEI) were prescribed in 74.2% and conditional sublingual nitroglycerin in 60.3%; both showed significant physician-dependent variability.
Impact:
- Prescriptions largely align with Andalusian quality standards for STEMI care.
- Physician variability in prescribing ACEI and sublingual nitroglycerin represents key areas for quality improvement.
- Standardizing prescription practices for these agents could enhance STEMI management consistency.
Objectives:
Cardiovascular disease is the primary cause of death in the world. Various drugs have shown their efficiency in the management of patients with acute coronary syndrome, along with the recommendations established by different Scientific Societies. The objective of this survey is to assess the monitoring of the quality standards established in Andalusia for the management of patients with myocardial infarction with evaluation of the ST segment and to analyse the source of variability of the prescription provided by the physician.
Method:
An observational descriptive survey, of indication-prescription, which analysed all the prescriptions included in the hospital discharge reports in patients treated in a tertiary hospital after having suffered acute myocardial infarction with ST segment elevation, between August 2005 and July 2007.
Results:
A total of 287 patients were included. Antiplatelets were prescribed in 99.3% of the patients, and acetylsalicylic acid in 95.8%. The percentage of beta-blockers received was 89.5%, angiotensin converting enzyme inhibitors (ACEI) in 74.2%, with ARA-II indicated in 2.85%. The use of statins was 84.6%. The indication of conditional sublingual nitroglycerin was 60.3%. The use of ACEI and sublingual nitroglycerin showed statistically significant differences according to the prescribing physician.
Conclusions:
The fitness of the prescriptions to the recommendations established in Andalusia is high. The prescription of conditional sublingual nitroglycerin is the indicator which varies most in the quality standards established. Its use in conjunction with the indication of ACEI, are the recommendations which show a higher deviation depending on the prescribing physician.
Related Concept Videos
01:20Angina V: Nursing Management
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Coronary Artery Disease V: Interprofessional Care
01:30Pulse rhythm
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac muscle...
01:22Myocarditis IV: Nursing Management