Introduction:
Specific guidelines exist for identification and treatment of patients at risk for sudden cardiac arrest (SCA); however, little data exist describing how often these patients are accurately identified and appropriately treated. The objectives of this prospective, single center study were to compare the effect of an electronic reminder and protocol on the ability to recognize patients at risk for SCA and the application of the guidelines for therapy.
Methods:
In this study an electronic reminder and protocol were used at one site, the main clinic (MC), compared to all other sites, regional clinics (RC). The protocol was based on current AHA/ACC and CMS guidelines with practice specific quality measures. The protocol included optimal medical treatment prior to ICD, temporary and absolute exclusions for ICD therapy. MC staff was trained to use a new process designed to better identify patients at risk for SCA. This included screening forms, a standardized patient education video, and a patented reminder tool for EMR systems to continue tracking patients that did not immediately qualify for ICD therapy. An independent review of medical charts for all patients visiting the MC and RC over a 2-month period was then conducted to evaluate the clinics ability to identify patients at risk for SCA and apply the current guidelines for appropriate care. Patients were followed for 6 months.
Results:
Table 1
. Recognition of patients at risk for SCA improved significantly from 70% at RC to 93% at MC. Application of the guidelines into practice as measured ultimately by optimal medical treatment combined with ICD implantation was significantly improved as well.
Conclusions:
Recognition rates of patients at risk for SCA and subsequent adoption of guideline-based therapy including optimal medical therapy and ICD implantation was significantly greater with the use of this novel protocol combining AHA/ACC and CMS guidelines with practice specific quality measures.
Table 1
We must identify patients at risk for pre-hospital sudden cardiac arrest at the early phase of myocardial infarction