1. Jensen, Kathy MSN, RN, CCNS, APRN,BC

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To consistently implement the American Heart Association's "Get With The Guidelines-CAD Program" through interdisciplinary process improvement initiatives. To optimize clinical outcomes for acute MI patients through improved compliance with evidence-based national guidelines for secondary prevention of coronary heart disease.



American Heart Association (AHA) projections have shown that implementation of cardiovascular disease secondary prevention guidelines nationwide as promoted by AHA's "Get With The Guidelines: CAD Program" could result in saving more than 80,000 lives each year.



Quality measures monitored and addressed were as follows: ASA, Beta Blocker, Ace Inhibitor, and lipid lowering therapy prescribed at discharge-Smoking Cessation counseling/literature provided prior to discharge.



The target population of this initiative was all STEMI and NSTEMI patients admitted to the Shawnee Mission Regional Cardiac and Vascular Center between 3rdQ 2004 and 2ndQ 2005. Following baseline assessment of performance multifaceted opportunities for improvement were identified and implemented by an interdisciplinary team facilitated by the CV CNS. Keys to success were interdisciplinary involvement, education and consistent feedback to key stakeholders, development of user-friendly tools to support the process, blinded individual physician reports, and administrative expectation of superior performance.



Greater than 85% of compliance with each of the 5 indicators was achieved for 4 consecutive quarters (ASA 100%, Beta Blocker 100%, ACE/ARB 99%, Statins 94%, Smoking Cessation Counseling 96%). During this time period, AMI mortality was reduced from 10% to 5.6%. The Outcome Sciences Opportunity for Lives Saved calculator noted a significant decrease in predicted composite repeat CAD events (1st and 2ndQ 2004-2.89 CAD events, 3rd and 4thQ 2004-0.58 CAD events, 1st and 2ndQ 2005-0.72 CAD events) during this time period.



As a result of improved compliance with evidence-based guidelines, mortality was decreased, clinical outcomes were improved, and the Shawnee Mission Regional Cardiac and Vascular Center was awarded the Get With the Guidelines-CAD Annual Performance Award at the 2005 AHA Scientific Sessions in Dallas, Texas.


Implications for Practice:

Compliance with national evidence-based secondary CAD prevention guidelines saves lives.