No abstract

Methods: Retrospective data was retrieved from patient records between April 2008-April 2009. The criteria for review was all patients with a diagnosis of acute STEMI and evidence of LVSD with an ejection fraction (EF) of 45% or less on echocardiogram or angiography. European, national and local guidelines were used as a benchmark to assess the care given to this cohort of patients. Results: It was found that as suspected less than 20% of patients had their medication titrated at their first clinical review. Indeed the audit indicated that only 29% of patients received routine follow up in 6 to 8 weeks as requested. The average length of wait for the first consultant review varied between 1.5 and 7 months. At 12 months post discharge only 35% of the cohort had their ace inhibitor titrated to the maximum tolerated dose as suggested by the National Institute of Clinical Excellence (NICE) (2003). Similarly only 31% of patients were optimised on a beta blocker. In addition the audit found that only 15% of patients had coronary risk factors discussed at their clinical review. Of the 30 patients who had EF less than 35% only 12 had documented evidence of ECG review during clinical follow up. It was also noted that only 25% of these patients had documented plans regarding 24hr ECG monitoring as indicated by NICE (2006). Conclusions: Changes to local policy which now include the assessment of left ventricular function by echocardiogram on all patients who have sustained an ST elevation myocardial infarction, has meant that the identification of LVSD has increased. The absence of local guidelines mean patients' post MI with LVSD, often receive fragmented care as highlighted by this audit. However this is not the case in many areas of the United Kingdom. In some areas patients are reviewed 6 weeks post infarct, usually in a multidisciplinary nurse led clinic where the emphasis is on looking for ischaemia, measuring LV function, making decisions about device therapy and getting cardiac rehabilitation started (McDonagh 2006). The nurse led clinic provides a unique opportunity for a more formal pathway to be developed enabling a more seamless transition for patients between cardiac rehabilitation and heart failure.