18 March 2009

Findings from a quality improvement project funded by the National Prescribing Service Ltd (NPS) focusing on optimising Discharge Management of Acute Coronary Syndromes (DMACS) in hospitals, show that guideline-recommended therapies are prescribed most frequently.

The DMACS project involves 49 public and private hospitals across Australia in collaboration with state based Therapeutic Advisory Groups/Drug Use Evaluation Groups in QLD, NSW, VIC, TAS and SA. The state groups represent experts in drug therapy (clinical pharmacologists, pharmacists and other clinicians) from the major teaching hospitals and affiliated academic units.

The project focuses on three key areas: prescription of cardiovascular medications; education on lifestyle modifications; and communication with patients and GPs.

“From June to December 2008, a baseline audit was completed in hospitals to understand management of patients with acute coronary syndromes (ACS),” NPS clinical expert, Education and Quality Assurance Program Manager, Judith Mackson said.

“Some of our results are consistent with the National Heart Foundation ACS Guideline recommendations and observations in the Australian Collaborative Acute Coronary Syndromes Prospective Audit (ACACIA) study, which described current practice of ACS care in Australia.“

“Of the five guideline recommended therapies, there were high prescribing rates for blood thinning/antiplatelet agents and statins/cholesterol lowering drugs compared with other proven therapies like ACE inhibitors and beta blockers. The ACACIA study provided the basis for quality improvement initiatives such as ours,” Ms Mackson said.

Key findings include:

• Among 1545 patients with a discharge diagnosis of ACS, guideline-recommended therapies were prescribed most frequently - antiplatelet agents (97%) and statins (92%), compared with angiotensin-modifying drugs (78%) and beta blockers (75%)
• 57% of 1545 patients with diagnosis of ACS were referred to cardiac rehabilitation before discharge
• Of 731 GPs who took part in a post-discharge survey, 77% reported receiving a discharge summary at the time of survey. Of these, 65% rated the quality of information from the hospital to be ‘very good’ to ‘excellent’
• Among 1319 patients that participated in the phone survey at 90 days post-discharge, 48% reported taking a combination of life-saving/guideline-recommended therapies (antiplatelet agents, beta blocker, angiotensin-modifying drugs, and statin)  

As part of the DMACS project, an educational intervention is being carried out in hospitals until May 2009. This includes feedback of baseline audit results and promotion of best practice guidelines followed by a repeat audit.

Key messages for health professionals include:

• Initiate a long-term management plan for all patients with ACS
• Consider guideline-recommended medications for all patients with ACS
• Identify risk factors and refer all patients with ACS to secondary prevention programs

Communicate management plan to the patient, carers and the community health care providers.

Final results of the DMACS project, including recommendations are expected by December 2009.

ENDS