INTERNATIONAL RESEARCH & OPINION Appropriate care underused in Medicare patients with acute MI A significant proportion of patients with acute myocardial infarction (MI) who are ideal candidates for therapy do not receive appropriate care, according to an analysis of data from the US Cooperative Cardiovascular Project. Quality of care was assessed among 4300 Medicare beneficiaries (mean age 74 years) with acute MI who were admitted to hospitals in Maryland and the District of Columbia. The proportion of patients defined as 'ideal'* candidates for treatment ranged from 11 % for thrombolytics to 100% for smoking cessation [see table ]. Indicators of healthcare quality included attempted reperfusion, timing of thrombolysis or coronary angioplasty, administration and timing of aspirin, use of ACE inhibitors for left ventricular (LV) dysfunction, avoidance of calcium antagonists for LV dysfunction, prescription of aspirin and at hospital discharge, and smoking cessation advice. I Use of quality indicators for acute myocardial infarction Quality indicator 'Ideal' patients (%)' 'Ideal' patients actually receiving therapy (%) Thrombolytic therapy 11 72 Aspirin 56 67 t ACE inhibitors for LV" 63 65 dysfunction I Avoidance of calcium 34 62 antagonists for LV dysfunction fl-Blockers on 22 45 discharge I Aspmn on discharge 49 n I Smoking cessation 100 41 'advice , Patients without contraindications who should receive the intervention. ! i ,. left ventricular The proportion of 'ideal' candidates who actually received therapy ranged from 41 % for smoking cessation advice to 87% for aspirin [see table]. All patients were eligible for 1 of the 7 quality indicators; however, 515 (12%) received none of the recommendations. * having no contraindications to therapy Berger AK, Edris DW, BreaU lA, Oetgen WI. Marciniak TA, et aI. Resource use and quality of care for Medicare patients with acute myocardial infarction in Maryland and the District of Columbia: analysis of data from the Cooperative Cardiovascular Project. American Heart Journal 135: 349-356, Part 1, Feb 1998 800647219 1173-5503198/0155-0009/$01.00° Adis International Limited 1998. All rights reserved PharmacoEconomics & Outcomes News 28 Mar 1998 No. 155 9

Appropriate care underused in Medicare patients with acute MI

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INTERNATIONAL RESEARCH & OPINION

Appropriate care underused in Medicare patients with acute MI

A significant proportion of patients with acute myocardial infarction (MI) who are ideal candidates for therapy do not receive appropriate care, according to an analysis of data from the US Cooperative Cardiovascular Project.

Quality of care was assessed among 4300 Medicare beneficiaries (mean age 74 years) with acute MI who were admitted to hospitals in Maryland and the District of Columbia. The proportion of patients defined as 'ideal'* candidates for treatment ranged from 11 % for thrombolytics to 100% for smoking cessation [see table ].

Indicators of healthcare quality included attempted reperfusion, timing of thrombolysis or coronary angioplasty, administration and timing of aspirin, use of ACE inhibitors for left ventricular (LV) dysfunction, avoidance of calcium antagonists for LV dysfunction, prescription of aspirin and ~-blockers at hospital discharge, and smoking cessation advice.

I Use of quality indicators for acute myocardial infarction

Quality indicator 'Ideal' patients (%)' 'Ideal' patients actually receiving

therapy (%)

Thrombolytic therapy 11 72

Aspirin 56 67

t ACE inhibitors for LV" 63 65 dysfunction

Avoidance of calcium 34 62 antagonists for LV dysfunction

fl-Blockers on 22 45 discharge

I Aspmn on discharge 49 n I Smoking cessation 100 41 'advice

, Patients without contraindications who should receive the intervention. !

i ,. left ventricular

The proportion of 'ideal' candidates who actually received therapy ranged from 41 % for smoking cessation advice to 87% for aspirin [see table].

All patients were eligible for ~ 1 of the 7 quality indicators; however, 515 (12%) received none of the recommendations. * having no contraindications to therapy

Berger AK, Edris DW, BreaU lA, Oetgen WI. Marciniak TA, et aI. Resource use and quality of care for Medicare patients with acute myocardial infarction in Maryland and the District of Columbia: analysis of data from the Cooperative Cardiovascular Project. American Heart Journal 135: 349-356, Part 1, Feb 1998

800647219