Improving Communication With GPs Post-STEMI

JJ Coughlan; Conor Hickie; Barbara Gorna; Ross Murphy; Peter Crean

Disclosures

Br J Cardiol. 2016;23(4):138-140. 

In This Article

Materials and Methods

In this study, we aimed to assess the compliance with guidelines on communication with GPs. Subsequently, we sought to improve this through education of our junior staff.

Using our STEMI database and the computerised discharge prescriptions on our electronic patient record (EPR) system, we analysed the prescribing rates of BB, DAPT, ACEi and statins for all patients presenting as STEMI calls in 2015. We also analysed the percentage of patients discharged on therapeutic doses of these medications. The presence or absence of clear instructions for GPs regarding up-titration of medication doses, duration of DAPT and repeating fasting lipid profiles was also noted.

For study purposes, the subtherapeutic doses of NICE recommended drugs for use post-MI were defined as those used in a previous audit on medication dosage post-STEMI:[10]

  • ACEi: lisinopril <10 mg per day, perindopril <4 mg per day, ramipril <5 mg per day

  • BB: atenolol <50 mg per day, bisoprolol <5 mg per day, carvedilol <25 mg per day, metoprolol <50 mg per day

  • Statins: atorvastatin <80 mg per day, rosuvastatin <10 mg per day, simvastatin <40 mg per day

  • Antiplatelets: aspirin <75 mg per day, clopidogrel <75 mg per day, ticagrelor <180 mg per day.

These were selected arbitrarily based on similar studies on therapeutic prescribing in the UK. Patients with no dose specified on the discharge prescription were classified as non-therapeutic.

It was felt that lack of education was a significant factor in our disappointing initial results. In order to tackle this, a short talk was delivered to the new junior doctors assigned to our service at the beginning of their cardiology rotation. This comprised of a brief overview of the NICE guidelines on communication with GPs post-STEMI, in addition to the results from our initial audit of practice over the previous year. A random sample of 34 consecutive STEMI discharges was then audited from the following three months (all STEMIs between 14 May 2016 to 14 June 2016) using similar methodology.

Rates of compliance were compared using the Z-test for two population proportions using a two-tailed test at a significance level of p<0.05.

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