Improving the performance measures of medical therapy in patients with acute myocardial infarction by pharmacist

Objectives: According to the 2008 ACC/AHA guideline of Performance Measures for Acute Myocardial Infarction (AMI), the use of five drugs, aspirin at arrival, and aspirin, clopidogrel, β-blocker, angiotensin-converting enzyme (ACE) inhibitor, and statin at discharge, can reduce reinfarction and mortality. We initiated an intensive intervention by pharmacist which aims to improve the prescription rate of the five drugs in post-MI patients.

Methods: For June to December 2011, the cardiology team in our institution initiated intensive program to achieve the disease-specific care certification of AMI. A pharmacist involved in the team will determine whether the five drugs were all prescribed to the AMI inpatients without contraindication, and will remind the physician if there was an omission on prescription. Patient education was also provided to maintain the treatment compliance after discharge. We then compared the prescription rates of the five drugs before and after the intervention. Data before the intervention were obtained from the pharmacy record between January 2010 and May 2011. Subjects were excluded if they were contraindicated to one of the five drugs, expired, transferred to another hospital, admitted from other hospital.

Results: 354 patients were included in this analysis (226 in before and 129 in after group). The prescription rates of aspirin at arrival were 100%, in both before and after intervention.  The prescription rates at discharge of aspirin, clopidogrel, ACEI, β-blocker and statin before intervention were 98.3%, 90.9%, 95.2%, 90%, respectively, and were all improved to reach 100% after intervention.

Conclusion: The prescription rate in the present study were fairly high than previous reports which may due to excluding patients from our data who have contraindication to drugs. This also demonstrated a great effect of performance measure of medical therapy in AMI via a strict management from a multidiscipline team including pharmacist.