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Quality improvement report
Improving medication optimisation in left ventricular systolic dysfunction after acute myocardial infarction
  1. Paul Forsyth1,
  2. Lynsey Moir1,
  3. Iain Speirits1,
  4. Steve McGlynn1,
  5. Margaret Ryan1,
  6. Anne Watson2,
  7. Fiona Reid2,
  8. Christopher Rush3,
  9. Clare Murphy3
  1. 1Pharmacy Services, NHS Greater Glasgow and Clyde, Glasgow, UK
  2. 2Pharmacy, NHS Education for Scotland, Glasgow, UK
  3. 3Cardiology, Royal Alexandra Hospital, Paisley, Renfrewshire, UK
  1. Correspondence to Paul Forsyth, Pharmacy Services, NHS Greater Glasgow & Clyde, Glasgow G76 7AT, UK; paul.forsyth{at}nhs.net

Abstract

Glasgow city has the highest cardiovascular disease (CVD) mortality rate in the UK. Patients with left ventricular systolic dysfunction after acute myocardial infarction represent a ‘high-risk’ cohort for adverse CVD outcomes. The optimisation of secondary prevention medication in this group is often suboptimal. Our aim was to improve the use and target dosing of ACE inhibitors (ACEI), angiotensin II receptor blockers (ARBs) and beta-blockers in such patients, through pharmacist-led clinics and cardiology multidisciplinary team collaboration. Retrospective audits characterised baseline care. Prospective pharmacist-led clinics were piloted and rolled out across seven hospitals and primary care localities over four Plan–Do–Study–Act cycles. ‘Hub’ and ‘spoke’ clinics utilised independent prescribing pharmacists with different levels of cardiology experience. Pharmacists were trained through a bespoke training programme—‘Teach and Treat’. Consultant cardiologists provided senior support and governance. Patients attending prospective pharmacist-led clinics were more likely to be prescribed an ACEI (or ARB) and beta-blocker (n=856/885 (97%) vs n=233/255 (91%), p<0.001 and n=813/885 (92%) vs n=224/255 (88%), p=0.048, respectively) and be on target dose of ACEI (or ARB) and beta-blocker (n=585/885 (66%) vs n=64/255 (25%), p<0.001 and n=218/885 (25%) vs n=17/255 (7%), p<0.001, respectively) compared with baseline. The mean dose of ACEI (or ARB) and beta-blocker was also higher (79% vs 48% of target dose, p<0.001% and 48% vs 33% of target dose, p<0.001, respectively) compared with baseline. Use of secondary prevention medication was significantly improved by pharmacist and cardiology collaboration. These improvements were sustained across a 4-year period, supported by a novel approach called ‘Teach and Treat’ which linked training to defined clinical service delivery. Further work is needed to assess the impact of the programme on long-term CVD outcomes.

  • Pharmacist
  • Evidence-Based Medicine
  • Multidisciplinary Team
  • Quality Improvement
  • Professional Development

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjoq-2019-000676

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    Footnotes

    • Contributors PF, AW, FR and CM contributed to the concept/design. PF contributed to the data analysis and is the lead author. PF, LM, IS, SM and CM delivered staff training/teaching and contributed to the project planning. PF and CM contributed to the funding bid. PF, LM, IS and SM contributed to the intervention. LM, IS, SM, MR, AW, FR, CR and CM contributed to the manuscript revision. MR, AW and FR contributed to the strategic workforce support. AW and FR are the funders and contributed to the intervention planning. CR contributed to the pilot data. CM contributed to the clinical/academic supervision.

    • Funding NHS Education for Scotland (pilot and training).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.