1. Prescribing Performance Post-Acute Coronary Syndrome Using a Composite Medication Indicator: ANZACS-QI 24.
- Author
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Kasargod, Chethan, Devlin, Gerry, Lee, Mildred, White, Harvey D., and Kerr, Andrew J.
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PLATELET aggregation inhibitors , *MYOCARDIAL infarction , *ACUTE coronary syndrome , *CORONARY artery bypass , *ACE inhibitors , *TREATMENT of acute coronary syndrome , *PATIENT aftercare , *LEFT heart ventricle , *RESEARCH , *ANTILIPEMIC agents , *RESEARCH methodology , *RETROSPECTIVE studies , *ACQUISITION of data , *EVALUATION research , *MEDICAL cooperation , *ADRENERGIC beta blockers , *CORONARY angiography , *COMPARATIVE studies , *QUALITY assurance , *ANGIOTENSIN receptors , *MEDICAL prescriptions , *HEART physiology , *STROKE volume (Cardiac output) , *LONGITUDINAL method , *DISCHARGE planning - Abstract
Background: Guidelines previously recommended use of dual antiplatelet therapy, statins, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) and beta blockers (five classes of drugs) in patients without contraindications or intolerance after acute coronary syndrome (ACS). However, recent guidelines have taken a more nuanced view regarding the use of ACEI/ARB and beta blockers. Our aim was to develop a composite post-discharge medication indicator, based on available evidence, to support quality improvement.Methods: 4,112 consecutive post-ACS patients who underwent coronary angiography and left ventricular ejection fraction (LVEF) assessment in 2015-16 were recorded in the All New Zealand ACS Quality Improvement (ANZACS-QI) registry. Patients receiving coronary artery bypass grafting were excluded. Three composite indicator algorithms that took into account known contraindications/intolerances were compared across NZ District Health Boards (DHBs): RESULTS: Overall and individual DHB performance was highest (74%, DHB range 52-84%) when reported using the NHFA/CSANZ indicator, and slightly lower (69%, DHB range 48-78%) on the ANZACS-QI indicator. Performance was lowest using the older five-drug-class indicator (65%, DHB range 48-77%).Conclusions: We have developed a composite post-discharge medication indicator appropriate for use in identifying gaps in evidence-based management across NZ, which is now being reported regularly to DHBs. [ABSTRACT FROM AUTHOR]- Published
- 2020
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