Improving medication optimisation in left ventricular systolic dysfunction after acute myocardial infarction

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Glasgow exhibits the highest cardiovascular disease (CVD) mortality in the UK.
• Patients with left ventricular systolic dysfunction post-myocardial infarction are a high-risk group.
• Secondary prevention medication optimization in this cohort is frequently suboptimal.

Purpose of the Study:

• To enhance the utilization and target dosing of ACE inhibitors (ACEI), angiotensin II receptor blockers (ARBs), and beta-blockers.
• To implement pharmacist-led clinics in collaboration with cardiology multidisciplinary teams.
• To improve secondary prevention strategies for high-risk CVD patients.

Main Methods:

• Retrospective audits to establish baseline care.
• Prospective pharmacist-led 'hub' and 'spoke' clinics across seven hospitals and primary care sites.
• Utilized independent prescribing pharmacists with varied cardiology experience, trained via the 'Teach and Treat' program.
• Four Plan-Do-Study-Act cycles guided the rollout and refinement of the clinics.
• Consultant cardiologists provided senior support and governance.

Main Results:

• Increased prescription rates for ACEI/ARB (97% vs 91%) and beta-blockers (92% vs 88%).
• Higher rates of patients achieving target doses for ACEI/ARB (66% vs 25%) and beta-blockers (25% vs 7%).
• Mean medication doses increased to 79% of target for ACEI/ARB and 48% for beta-blockers, significantly above baseline (48% and 33%, respectively).

Conclusions:

• Pharmacist and cardiology collaboration significantly improved secondary prevention medication use and dosing.
• The 'Teach and Treat' program facilitated sustained improvements over a four-year period.
• Further research is warranted to evaluate the long-term impact on cardiovascular outcomes.