ACC AMI GAP

ACC AMI GAP Trial Design: ACC AMI GAP was a study designed to assess compliance and use of ACC AMI Guidelines recommendations prior to and following monitoring of guideline use and with the use of guideline tools, including standing orders, pocket guidelines, discharge contracts, patient information form, and critical pathways. Follow-up was performed at 12 months to assess change in compliance. Early ASA use Late ASA use p<0.05, base p<0.001, base to remeasure; to remeasure; p<0.001, base to p<0.001, base to remeasure+tools remeasure+tools

100

85 87

91

90

Smoking LDL Cessation Management Therapy p<0.05, base p<0.001, base to remeasure; to remeasure; p<0.001, base to p<0.001, base to remeasure+tools remeasure+tools

94 87

86

82

80

73

78

68 60

%

51

Results

• Use of several standard order

therapies increased with remeasurement: early ASA and late ASA, beta blocker, ACE-I, smoking cessation, LDL management and diet counseling • Additional improvements seen with post-tool implementation for: early ASA, beta-blocker, LDL management and late ASA, beta blocker, ACE-I, smoking cessation, LDL management and diet counseling • In-hospital mortality 11.9% at baseline and 9.1% at remeasurement

Conclusions

• Implementation of ACC AMI

40

20

0 Baseline

Remeasurement

Remeasurement with Tools

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ACC CURRENT JOURNAL REVIEW Sep 2004

15

Guidelines Applied in Practice was associated with improvements in quality of care for patients with acute MI as assessed by guideline recommendation adherence • Use of GAP tools was associated with an even larger improvement in quality of care • Improvements seen in both early and late standard therapies ACC 2003 Late Breaking Trials