Evaluation of the implementation of a local treatment guideline in secondary prevention post-myocardial infarction

The objectives of this study were to validate and implement an audit tool to assess quality and appropriateness of prescribing and to compare inpatient prescribing of secondary prevention in post myocardial infarction patients before and after introduction of a local treatment guideline. The methodology involved a descriptive, non-experimental retrospective case note review comparing patients treated before and after the implementation of a clinical guideline. The analysis of Group1 patients showed that 41% required treatment with an angiotensin converting enzyme inhibitor (ACE-I), and 23% of those did not receive treatment, 20% of patients on ACE-I received sub-therapeutic doses. Seventy-two per cent of patients required treatment with a statin and 22% of those did not receive a statin. Comparison of the treatment of Group 2 showed that, of 53 patients (50% of Group 2) requiring an ACE-I, 100% received it, although 15% received sub-therapeutic doses. Of 69 patients (64% of Group 2) requiring treatment with a statin 96% were prescribed a statin. Improvements in prescribing of β-Blockers, ACE-I and statins were statistically significant. The study found that prescribing improved significantly for β-Blockers, ACE-I and statins after guideline introduction with anticipated benefits to patient outcomes.