Table 1

Comparison of ACEI (or ARB) and beta-blocker optimisation in baseline audits versus pharmacist-led clinics

PDSA Cycle 1 (1 September 2013–31 August 2014)PDSA Cycle 2 (1 September 2014–31 August 2015)PDSA Cycle 3 (1 September 2015–31 August 2016)Combined baseline auditsPDSA Cycle 4
(1 September 2016–31 August 2017)
Initial baseline audit
(n=57)
Pharmacist clinics
(n=51)
Baseline audit new site
(n=58)
Pharmacist clinics*
(n=194)
Baseline audit new site
(n=76)
Baseline audit new site
(n=64)
Pharmacist clinics*
(n=454)
Baseline audit all sites (n=255)Pharmacist clinics*
(n=885)
Hospitals1, 21, 231, 2, 3, 4†561, 2, 3, 4†, 5, 61, 2, 3, 5, 61, 2, 3, 4†, 5, 6, 7‡
Semiquantitative LVSD grading rangeModerate–severeModerate–severeMild–severeMild–severeMild–severeMild–severeMild–severeMild–severeMild–severe
Age67.160.467.562.661.462.262.164.362.1
Baseline blood pressure, mm Hg (mean)§119/68123/77125/69122/74118/69135/80123/73124/72123/72
Baseline pulse, beats per minute (mean)§686869676667676766
Number of pharmacist reviews (mean)N/A4.6N/A4.2N/AN/A4.2N/A4.1
ACEI (or ARB) dosing, n (% patients)
 0% of target dose6 (11)3 (6)5 (9)9 (5)9 (12)2 (3)14 (3)22 (9)29 (3)
 1%–24% of target dose3 (5)1 (2)9 (16)5 (3)6 (8)3 (5)11 (2)21 (8)35 (4)
 25%–49% of target dose23 (40)8 (16)14 (24)25 (13)29 (38)15 (23)41 (9)81 (32)86 (10)
 50%–74% of target dose13 (23)9 (18)14 (24)26 (13)18 (24)19 (30)72 (16)64 (25)124 (14)
 75%–99% of target dose0 (0)1 (2)2 (3)3 (2)0 (0)1 (2)9 (2)3 (1)26 (3)
 100% of target dose12 (21)29 (57)14 (24)126 (65)14 (18)24 (38)307 (68)64 (25)585 (66)
Mean percentage of target ACEI/ARB dose
­
­
44%72%48%77%42%61%80%48%79%
Beta-blocker dosing, n (% patients)
 0% of target dose10 (18)2 (4)5 (9)14 (7)9 (12)7 (11)38 (8)31 (12)72 (8)
 1%–24% of target dose9 (16)5 (10)8 (14)17 (9)20 (26)8 (13)46 (10)45 (18)111 (13)
 25%–49% of target dose19 (33)12 (24)29 (50)57 (29)30 (39)17 (27)130(29)95 (37)262 (30)
 50%–74% of target dose14 (25)13 (25)11 (19)43 (22)11 (14)20 (31)83 (18)56 (22)166 (19)
 75%–99% of target dose1 (2)4 (8)1 (2)9 (5)4 (5)5 (8)27 (6)11 (4)56 (6)
 100% of target dose4 (7)15 (29)4 (7)54 (28)2 (3)7 (11)130 (29)17 (7)218 (25)
Mean percentage of target beta-blocker dose31%56%33%52%28%41%51%33%48%
  • 1=Royal Alexandra Hospital, 2=Vale of Leven Hospital, 3=Glasgow Royal Infirmary, 4=West Glasgow Ambulatory Care Centre, 5=New Victoria Hospital, 6=Queen Elizabeth University Hospital, 7=Inverclyde Royal Hospital.

  • *Running tota.

  • †Baseline data not available for site four due to original hospital site closing during time period.

  • ‡Baseline data not available for site four due to lack of cardiac rehabilitation database.

  • §Result taken from first cardiac rehab or first pharmacist review postdischarge.

  • .ACEI, ACE inhibitor; ARB, angiotensin receptor blocker;LVSD, left ventricular systolic dysfunction; N/A, not applicable; PDSA, Plan–Do–Study–Act.