Following evidence-based practice guidelines and standardized treatment protocols can help improve the quality of care of patients being treated for a heart attack, according to the one- year results of a study published in the March 13 Journal of the American Medical Association (JAMA).

Under the auspices of the American College of Cardiology Foundation's (ACCF) Guidelines Applied in Practice, or GAP, initiative, medical staff at 10 southeastern Michigan hospitals used a "tool kit" to help support their efforts to provide high-quality care for patients who had been admitted with an acute myocardial infarction, or heart attack. The results of the program were impressive. Before implementation of the ACCF-GAP program, for instance, only 65 percent of heart attack patients received beta-blockers within 24 hours of arriving at the hospital; afterward, that figure rose to 74 percent. Similarly, the percentage of patients receiving aspirin within 24 hours of admittance rose from 81 percent to 87 percent, and the percent of patients who were prescribed aspirin on discharge from the hospital rose from 82 percent to 92 percent. These changes mean fewer people will die from their heart disease.

"The GAP project provided for greater consistency of care regardless of age or gender, and closed the gap of care that existed for the elderly and female patients in several areas of care," said Kim Eagle, MD, the principal investigator for the ACCF-GAP initiative. "For patients, this means an improved quality of care while they are in the hospital and improved outcomes after discharge."

Use of beta-blockers in patients admitted for a heart attack, for example, has been shown to reduce the risk of death one year after discharge by 20-25 percent. Similarly, use of aspirin in heart attack patients at admission and at discharge can reduce the risk of future heart attacks by a similar percentage. Smoking-cessation counseling, which improved from 53 percent to 65 percent, is particularly important because studies have shown that quitting smoking can reduce the risk of a second heart attack and heart disease-related death by 50 percent or more.

  The GAP Tool Kit includes:

  *  a pocket guideline-an easy-to-use, condensed version of the
     ACC/American Heart Association (AHA) Practice Guidelines for the
     Management of Patients With Acute Myocardial Infarction;

  *  standard order sets, which serve as a trigger for physicians to make
     decisions about proven therapeutic measures in heart attack patients
     and that allow them to easily order and document appropriate care;

  *  a "critical pathway" for nurses, which helps them track
patients
     through the normally expected course of events during hospitalization;
     and

  *  materials for patients to use after they leave the hospital that remind
     them about the importance of taking their medications, improving their
     diet, and other activities aimed at preventing future cardiovascular
     events.

"The tool kit helps ensure that the doctor, nurse, and patient are all in agreement on the key priorities of care from admission to discharge and beyond," Dr. Eagle explained. "When there is a system to remind all three of the key targets for care throughout the patient's stay, the level of adherence to these priorities improves and patients get better care."

The basis for several components of the GAP Tool Kit is the ACC/AHA practice guidelines for heart attack care-one of the 17 ACC/AHA practice guidelines developed by the top experts in cardiovascular medicine.

"The College has developed and published clinical practice guidelines for cardiovascular care for more than 15 years. These guidelines are intended to improve the effectiveness of care, optimize patient outcomes, and reduce the overall cost of care," said Raymond Gibbons, MD, chair of the ACCF committee overseeing the College's GAP program. "However, these benefits do not always occur, as guidelines are not always followed in every day clinical practice. The landmark results of the ACCF-GAP project show that it is possible to improve the use of guidelines and thereby improve the quality of care."

Because of its success in Michigan, Dr. Gibbons noted, the ACCF-GAP initiative is already being expanded to other areas of cardiovascular disease care, including the launch of similar GAP studies aimed at improving the treatment of heart failure in physician practices in Oregon and the treatment of stable angina (chest pain) in physician practices in Alabama.

In addition to being published in JAMA, results of the GAP initiative in Michigan, focusing on women and the elderly, will be presented at a news conference at the ACC 2002 Scientific Session in Atlanta on March 19 at 11:30 a.m.

More information about the ACCF-GAP program is available on the ACC Web site at http://www.acc.org/gap/gap.htm . The GAP tools for heart attack treatment may be downloaded at no cost from today's and tomorrow's issues of Vidyya. Today, four of the tools appear, tomorrow, you will have access to the remaining three.

The GAP Project was a partnership of the ACCF, the Michigan Peer Review Organization, and the Greater Detroit Area Health Council, which included an unrestricted research grant from Pfizer Inc.