title: Implementing a pathway for the management of acute coronary syndrome leads to improved compliance with guidelines and a decrease in angina symptoms.
abstract: We describe our experience with the Advanced Cardiac Admission Program (ACAP) at our institution. The ACAP program is a hospital-wide implementation of critical pathways-based management of all cardiac patients. Data review of patients admitted for acute coronary syndromes from the ACAP-PAIN database and a comparative study of outcomes before and after implementation of the pathways-based assessment and treatment protocols. In the pre-ACAP and post-ACAP patient groups, antiplatelet use at admission improved from 50% to 75% (p<.01), ACE-I use improved from 32% to 54% (p<.0001), statins use increased from 35% to 62% (p<.0001), and smoking cessation awareness increased from 15% to 86% (p<.0001). At 1-year follow-up, 84% of patients with CAD were treated with statins, and 47% had LDL cholesterol <100 mg/dL, compared with 20% and 9%, respectively, with conventional treatment before ACAP implementation (p<.0001). Recurrent angina symptoms and nonfatal myocardial infarction rates decreased from 28.5% to 13% (p = .02), and 15% to 5% (p = 0.03), respectively. Pathway-based programs like ACAP significantly enhance administration of guidelines-based cardioprotective medications both during hospital stay and at 1-year follow-up.
authors: St Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons. ea2168@columbia.edu
authors: Emad F
authors: EF
authors: Aziz
authors: Fahad
authors: F
authors: Javed
authors: Sandeep
authors: S
authors: Pulimi
authors: Balaji
authors: B
authors: Pratap
authors: Maria E
authors: ME
authors: De Benedetti Zunino
authors: Deborah
authors: D
authors: Tormey
authors: Mun K
authors: MK
authors: Hong
authors: Eyal
authors: E
authors: Herzog
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D019091:Critical Pathways / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D016896:Treatment Outcome; D016903:Drug Monitoring
chemical_list: D002316:Cardiotonic Agents