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

Objective: to validate and implement an audit tool to assess quality and ap propriateness of prescribing. To compare in-patient prescribing of secondar y prevention in post myocardial infarction patients before and after introd uction of a local treatment guideline. Method: descriptive, non-experimental retrospective case note review compar ing patients treated before and after the implementation of a clinical guid eline. Main outcome: comparison of quality of prescribing in two patient groups Results: Analysis of Group1 patients showed that 41% required treatment wit h an angiotensin converting enzyme inhibitor (ACE-I), and 23% of those did not receive treatment, 20% of patients on ACE-I received sub-therapeutic do ses. 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% re ceived 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 statist ically significant. Conclusions: Prescribing improved significantly for b-Blockers, ACE-I and s tatins after guideline introduction with anticipated benefits to patient ou tcomes.