Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2004;57:1017-28 - Vol. 57 Num.11 DOI: 10.1016/S1885-5857(06)60187-4

Effect of a Simple Educational Program for Physicians on Adherence to Secondary Prevention Measures After Discharge Following Acute Coronary Syndrome. The CAM Project

Javier Muñiz García a, Juan J Gómez Doblas b, María I Santiago Pérez c, Eduardo de Teresa Galván b, José M Cruz Fernández d, Alfonso Castro Beiras e

a Instituto de Ciencias de la Salud de la Universidad de La Coruña, La Coruña, Spain.
b Servicio de Cardiología. Hospital Universitario Virgen de la Victoria. Málaga, Spain.
c ODDS, S.L., La Coruña, Spain.
d Servicio de Cardiología, Hospital Universitario Virgen Macarena, Sevilla, Spain.
e Instituto de Ciencias de la Salud de la Universidad de La Coruña, La Coruña, Spain. Servicio de Cardiología, Hospital Juan Canalejo, La Coruña, Spain.

Keywords

Myocardial infarction. Unstable angina. Guideline adherence. Quality indicators.

Abstract

Introduction and objectives. Adherence to established guidelines for patients discharged from the hospital after acute coronary syndrome is known to be suboptimal. The aim of this study was to assess the efficacy of a program for physicians centered on the treatment of acute coronary syndrome. Patients and method. 39 hospitals participated. Intervention: a set of measures was developed by consensus for the creation and distribution of educational materials. Outcomes of interest: Proportion of patients in whom ejection fraction and residual ischemia were evaluated, treatment at discharge, and health and dietary recommendations to patients (smoking, diet, exercise, etc.) referred to all patients in whom these measures or treatments should have been used («ideal patients»). Changes were assessed with four cross-sectional surveys. Results. A total of 1157, 1162, 1149 and 1158 patients were included. There were no relevant differences between these groups in baseline characteristics. In general, there was improvement in all variables between the first and the last survey. The proportion of patients who were weighed and measured increased (from 33.5% to 53.4%; P<.0001), as did the proportion of those in whom cholesterol was measured early (42.6 to 53.7%; P=.006). The proportion in whom residual ischemia was not measured despite indications for this test decreased (18.2% to 10.8%; P=.013), and the proportion increased for appropriate treatment with statins on discharge (68.6% to 81.4%; P<.0001), advice to quit smoking (60.1% to 72.2%; P<.0001) and advice to exercise (58.3% to 67.4%; P=.003). Conclusions. The educational intervention seems to have had a positive effect on improving the appropriateness of procedures and treatments for patients discharged after acute coronary syndrome.

1885-5857/© 2004 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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