To assess whether implementation of guidelines increases the prescription of drugs, particularly bêta blockers, recommended for secondary prevention after acute myocardial infarction.
Prescription patterns among 355 patients discharged from a public teaching hospital after recovery from myocardial infarction were prospectively monitored in a before-after trial.
The implementation strategies included educational interventions (large group meetings), placement of guidelines in patients'records, and bimonthly general reminders sent to physicians.
Beta blockers were prescribed in 93 (38%) of 243 survivors ofacute myocardial infarction before guideline implementation (12-month control period), as compared with 71 (63%) of 112 patients (P<0.001) after their implementation (6-month period).
During the entire study period, the prescription of bêta blockers at a neighboring public teaching hospital, used as a comparison, was unchanged.
After adjusting for potential confounders, implementation of the guidelines remained significantly associated with prescription of bêta blockers at discharge [odds ratio (OR)=10 ; 95% confidence interval (Cl), 3.2 to 33 ; P<0.001]. Other independent predictors of prescription of bêta blockers were previous coronary artery bypass grafting (OR=8.7 ; 95% Cl, 2.5 to 31 ; P=0.001), hypertension (OR=2.5 ; 95% Cl, 1.4 to 4.5 ; P=0.003), age per 10-year increase (OR=0.82 ; 95% CI, 0.67 to 0.99 ; P=0. (...)
Mots-clés Pascal : Infarctus, Myocarde, Aigu, Bloquant bêta-adrénergique, Prévention, Secondaire, Implémentation, Guide pratique, Recommandation, Chimiothérapie, Efficacité, Homme, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie
Mots-clés Pascal anglais : Infarct, Myocardium, Acute, Beta blocking agent, Prevention, Secondary, Implementation, Handbook, Recommendation, Chemotherapy, Efficiency, Human, Cardiovascular disease, Coronary heart disease, Myocardial disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0280937
Code Inist : 002B02F05. Création : 16/11/1999.