Intervention to improve adherence to ACC/AHA recommended adjunctive medications for the management of patients with an acute myocardial infarction

Background: The most recent published guidelines regarding management of pa tients surviving an acute myocardial infarction (AMI) advocate the administ ration of aspirin (ASA), beta blockers (BB), and angiotensin-converting enz yme inhibitors (ACEi) and discourages the use of calcium-channel blockers ( CCB). Previous data collected in our region from the National Registry (NR) showed a dismal compliance with these guidelines. In an attempt to increas e physician awareness and to optimize implementation of recommended guideli nes, a cardiac and pharmacy steering committee was created. Methods: The pharmacist assigned to the project identified all patients adm itted with an AMI using troponin-I and creatine kinase-PI MB (CK-MB) report s. The pharmacist then contacted physicians to make recommendations if an a djunctive medication was not prescribed for a patient with no apparent cont raindications. Administration rates far ASA, BE, ACEi, and CCB were then as sessed and compared with the previously obtained baseline data from the NR. Results: At admission, the use of ASA increased from 70 to 72%, BE from 45 to 72%, and ACEi from 12 to 44%. In terms of medications at discharge, ASA use increased from 74 to 88%, BE from 55 to 76%, and ACEI from 30 to 40%. I n addition, the prescription rates for CCB at discharge decreased from 36 t o 21%. Conclusions: An interdisciplinary approach for disease management is an eff ective method for improving adherence to treatment guidelines simply with p harmacy intervention. The percentage of patients receiving the recommended adjunctive medications increased significantly. We propose that these guide lines should be periodically inserviced to physicians. Furthermore, patient counseling sessions should also be instituted to help reinforce the import ance of compliance with the medications after discharge, as well as lipid m anagement and smoking cessation.