Download Treatment of Acute Myocardial Infarction

Treatment of Acute Myocardial Infarction
(Indicator Set: Primary Health Care Providers)
Descriptive
Definition
Percentage of patient population who have had an acute myocardial
infarction (AMI) and are currently prescribed a beta-blocking drug.
Method of
Calculation
Numerator
Number of individuals in the denominator who are
currently prescribed a beta-blocking drug.
Inclusions
• Individual is in the denominator
• Individuals who had one or both of the following:
− Individual was prescribed a beta-blocking
drug within the past 12 months
− Individual has a contraindication to
beta-blocking drugs
Exclusions
None
Denominator
Number of primary health care (PHC) clients/
patients who had an AMI between 12 and
24 months ago.
Inclusions
• PHC client/patient
• Individual had an acute myocardial infarction
between 12 and 24 months ago
Exclusions
None
Data Source
Electronic medical record
Notes
Definitions of Terms
• A PHC client/patient is an individual who has had contact with the
provider at least once in the past year and has a record with the
provider dating back at least two years.
Interpretation
• A high rate for this indicator can be interpreted as a positive result.
Indicator Rationale
A heart attack, or AMI, is a life-threatening event that occurs when
the coronary arteries supplying blood to the muscles of the heart are
suddenly blocked. A section of the heart muscle may become damaged
or die as a result of reduced blood supply. Heart attacks are one of the
leading causes of morbidity and mortality in Canada.1 In 2008–2009,
more than 66,000 Canadians were hospitalized for heart attacks and
approximately 3.4% of those individuals suffered more than one heart
attack in a year.2
Treatment of Acute Myocardial Infarction
(Indicator Set: Primary Health Care Providers) (cont’d)
Patients who have suffered a heart attack and those with established
cardiovascular disease are at very high risk of experiencing recurrent
cardiovascular events.3 Evidence-based guidelines recommend
treatment with beta blockers as first-line antihypertensive therapy for
patients who have experienced an AMI and those with coronary artery
disease with angina. Treatment with angiotensin-converting enzyme
inhibitors is recommended for patients with diabetes mellitus or a
history of myocardial infarction, especially for those with impaired
left ventricular systolic function.4, 5
Despite widespread dissemination of guidelines for the management
of AMI, many patients are not receiving recommended treatment.
Between 1997 and 2000, rates of prescription for beta blockers within
30 days of discharge for elderly patients with AMI were lower than 50%
in some parts of Canada.6, 7
PHC providers play a vital role in the health and survival of their
patients once they are discharged from hospital after an AMI.
Necessary pharmacotherapy must be initiated or continued and
monitored in order to prevent recurrence or complications.
References
1. Statistics Canada. Leading Causes of Death in Canada. 2008.
http://www.statcan.gc.ca/bsolc/olc-cel/olc-cel?catno=84-215X&lang=eng. (84-215-XWE).
2. Canadian Institute for Health Information. Health Indicators 2010.
Ottawa, Ontario: CIHI; 2010. https://secure.cihi.ca/estore/
productSeries.htm?pc=PCC140.
3. World Health Organization. Prevention of Cardiovascular Disease:
Pocket Guidelines for Assessment and Management of
Cardiovascular Risk. Geneva: WHO Press; 2007.
4. Tobe SWM, Stone JAM, Brouwers MP, et al. Harmonization of
guidelines for the prevention and treatment of cardiovascular
disease: the C-CHANGE Initiative. [Miscellaneous Article]. CMAJ
Canadian Medical Association Journal. October 18, 2011;
183(15):e1135-e1150.
5. The Cleveland Clinic. Disease Management Project.
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanage
ment/cardiology/coronary-artery-disease/. Updated August 1, 2010.
Accessed August 27, 2012.
6. Pilote L, Beck CA, Karp I, et al. Secondary prevention after acute
myocardial infarction in four Canadian provinces, 1997-2000.
Canadian Journal of Cardiology. January, 2004;20(1):61-67.
7. Beck CAM, Richard HM, Tu JVM, Pilote LMMP. Administrative Data
Feedback for Effective Cardiac Treatment: AFFECT, A Cluster
Randomized Trial. [Article]. JAMA. July 20, 2005;294(3):309-317.
For more information on the PHC indicators, data sources and reporting initiatives, visit CIHI’s
website at www.cihi.ca/phc or send us an email at [email protected].
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