The association between guideline-based treatment instructions at the point of discharge and lower 1-year mortality in Medicare patients after acute myocardial infarction: The American College of Cardiology's Guidelines Applied in Practice (GAP) initiative in Michigan

Rogers, Adam M.; Ramanath, Vijay S.; Grzybowski, Mary; Riba, Arthur; Jani, Sandeep M.; Mehta, Rajendra H.; Franco, Anthony C. De; Parrish, Robert; Skorcz, Stephen; Baker, Patricia L.; Faul, Jessica D.; Chen, Benrong; Roychoudhury, Canopy; Elma, Mary Anne; Mitchell, Kristi; Froehlich, James B.; Montoye, Cecelia; Eagle, Kim A.

doi:10.1016/j.ahj.2007.05.003

Cited by 57 publications

(39 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…25 Because this study, in contrast to the beforementioned studies, included a control group, it was possible to compare the differences in change of outcome between QUICC and control hospitals. The QUICC hospitals showed a numerically larger decrease in clinical events, 2.9 fewer deaths and 4.4 fewer cardiac readmissions per 100 patient years, compared to the control hospitals.…”

Section: ) Nsmentioning

confidence: 99%

Improved Clinical Outcome After Acute Myocardial Infarction in Hospitals Participating in a Swedish Quality Improvement Initiative

Carlhed

Bojestig²,

Peterson³

et al. 2009

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

Background— The Swedish quality improvement initiative Quality Improvement in Coronary Care previously demonstrated significant improvements in caregiver adherence to national guidelines for acute myocardial infarction. The associated impact on 1-year clinical outcome is presented here. Methods and Results— During the baseline period July 2001 to June 2002, 6878 consecutive acute myocardial infarction patients <80 years were included at the 19 intervention and 19 control hospitals and followed for a mean of 12 months. During the postintervention period of May 2003 to April 2004, 6484 patients were included and followed in the same way. From baseline to postintervention, improvements in mortality and cardiovascular readmission rates (events per 100 patient-years) were significant in the intervention group (−2.82, 95% CI −5.26 to −0.39; −9.31, 95% CI −15.48 to −3.14, respectively). However, in the control hospitals, there were no significant improvements (0.04, 95% CI −2.40 to 2.47; −4.93, 95% CI −11.10 to 1.24, respectively). Bleedings in the control group increased in incidence (0.92, 95% CI 0.41 to 1.43), whereas the incidence remained unchanged in the intervention group (0.07, 95% CI −0.44 to 0.58). When the difference of changes between the study groups were evaluated, the results still were in favor of the intervention group, albeit significant only for bleeding complications (mortality: −2.70, 95% CI −6.37 to 0.97; cardiovascular readmissions: −6.85, 95% CI −16.62 to 2.93; bleeding complications: −0.82, 95% CI −1.66 to 0.01). Conclusions— With a systematic quality improvement initiative aiming to increase the adherence to acute myocardial infarction guidelines, it is possible to achieve long-term positive effects on clinical outcome.

show abstract

Section: ) Nsmentioning

confidence: 99%

Improved Clinical Outcome After Acute Myocardial Infarction in Hospitals Participating in a Swedish Quality Improvement Initiative

Carlhed

Bojestig²,

Peterson³

et al. 2009

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

show abstract

“…Promulgation of clinical practice guidelines (CPG) is intended to synthesize available medical information and improve quality of care [1][2][3][4][5][6][7] . Barriers to their application, however, often limit their implementation in daily practice 8,9 .…”

mentioning

confidence: 99%

The Gap Between Practice and Guidelines in the Choice of First-line Disease Modifying Antirheumatic Drug in Early Rheumatoid Arthritis: Results from the ESPOIR Cohort

Benhamou¹,

Rincheval²,

Roy³

et al. 2009

J Rheumatol

View full text Add to dashboard Cite

ABSTRACT. Objective. To compare rheumatologists' prescription for first disease modifying antirheumatic drug (DMARD) . "Definite" and "probable" RA were defined according to ACR criteria and the level of diagnostic certainty. The objectives were to assess conformity between the observed first-line DMARD prescribed for those patients and the DMARD recommended in the guidelines; and to conduct a mail survey of patients' usual rheumatologists to investigate the reasons for their nonconformity with guidelines. Results. In total 627 patients with definite or probable RA were identified. Conformity rates were 58% for STPR guidelines and 54% for EULAR guidelines. At 6 months, 83 (34%) patients with early RA did not receive any DMARD. Main determinants associated with conformity to guidelines were disease activity and presence of severity-predictive factors. The main reason leading to a discrepancy between guidelines and daily practice appeared to be diagnostic uncertainty, i.e., the difficulty to reliably assess RA diagnosis as early as the first visits to the rheumatologist. Conclusion.There is a substantial gap between CPG and rheumatologists' daily practice concerning the first DMARD to prescribe in early RA. This is explained mainly by diagnostic uncertainty. More attention should be paid in future guidelines to the diagnostic difficulties of early

show abstract

“…One tool used in this program was the introduction of standardized sets of admission and discharge orders to help minimize accidental omission and the requirement for physicians to document why EBTs had not been prescribed. 5 Use of such tools was associated with improvement in guideline medication provision and 1-year mortality. 5 When not prescribed, clear statements on the rationale for omission may be of further help to physicians providing long-term care, so that informed deci- …”

Section: Discussionmentioning

confidence: 99%

“…Provision of evidence-based medical treatments (EBTs) is associated with improved survival. [2][3][4][5][6] Quality-improvement initiatives have thus focused on improving adherence to guideline recommendations for secondary prevention. [7][8][9] Despite this, most observational data suggest that treatment-eligible patients in the highest objective risk score categories are the least likely to receive EBTs.…”

mentioning

confidence: 99%

Optimal Medical Therapy for Non–ST-Segment–Elevation Acute Coronary Syndromes

Bagnall

Yan²,

Yan³

et al. 2010

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

Background-Acute coronary syndrome (ACS) patients in the highest risk categories are least likely to receive evidence-based treatments (EBTs). We sought to determine why physicians do not prescribe EBTs for patients with non-ST-segment-elevation ACSs and the factors determining use of these treatments after 1 year. Methods and Results-One thousand nine hundred fifty-six non-ST-segment-elevation ACS patients were enrolled in the prospective, multicenter Canadian ACS registry II between October 2002 and December 2003. Each patient's physician gave reasons why guideline-indicated medication(s) was not prescribed during hospitalization. Medication use and reason(s) for discontinuation after 1 year were obtained by telephone interview of the patients. The commonest reason for not prescribing EBTs was "not high-enough risk" or "no evidence/guidelines to support use." However, Global Registry of Acute Coronary Events scores of patients not treated for this reason were often similar to or higher than those of patients prescribed such treatment. After 1 year, 77% of patients not on optimal ACS treatment at discharge remained without optimal treatment, and overall antiplatelet, ␤-blocker, and angiotensin-converting enzyme inhibitor use declined. Approximately one third of patients not taking EBTs had stopped their medication without instruction from their doctor. Conclusions-Nonprovision of EBTs may be due to subjective underestimation of patient risk and hence, likely treatment benefit. Oversights in care delivery were also apparent. Objective risk stratification, combined with efforts to ensure provision and adherence to EBTs, should be encouraged. (Circ Cardiovasc Qual Outcomes. 2010;3:530-537.)

show abstract

The association between guideline-based treatment instructions at the point of discharge and lower 1-year mortality in Medicare patients after acute myocardial infarction: The American College of Cardiology's Guidelines Applied in Practice (GAP) initiative in Michigan

Cited by 57 publications

References 22 publications

Improved Clinical Outcome After Acute Myocardial Infarction in Hospitals Participating in a Swedish Quality Improvement Initiative

Improved Clinical Outcome After Acute Myocardial Infarction in Hospitals Participating in a Swedish Quality Improvement Initiative

The Gap Between Practice and Guidelines in the Choice of First-line Disease Modifying Antirheumatic Drug in Early Rheumatoid Arthritis: Results from the ESPOIR Cohort

Optimal Medical Therapy for Non–ST-Segment–Elevation Acute Coronary Syndromes

Contact Info

Product

Resources

About