Can Clinical Reminder Help Optimize the Use of Secondary Prevention Therapies in Non-ST Elevation Acute Coronary Syndrome?

Patients with ACS remain at high risk of major coronary events and require further therapy to improve their survival and lower morbidity. A total of 35 Canadian hospitals participated and enrolled NSTEMI ACS patients admitted with the first event. Patients surviving to hospital discharge were followed up at 4 and 6 months to assess the use of recommended secondary prevention measures. Physicians were reminded of the recommended secondary prevention measures by way of a clinical reminder which was shown if an individual patient management did not conform to the recommendations. A total of 423 patients (70% male) who were 63.4 ± 11.2 years old were recruited by 28 hospitals. Systolic and diastolic BP was 140 ± 23 and 80 ± 14 mmHg, respectively and the heart rate was 75±15 beats per minute. Time from symptom onset to presentation was 1-12 hours in 57%, 12-24 hours in 20%, and > 24 hours in 23%. Presenting ECG was normal in 43%, revealed T wave inversion in 30%, ST segment depression in 26% and non-specific changes in 18%. While in hospital 93% of patients had an angiogram, PCI was performed in 67% and CABG in 12%. Recommended secondary prevention measures were prescribed in only 31% of patients at hospital discharge; the use of the clinical reminder was associated with significant increase in secondary prevention treatments during the follow up (p =0.0072). Simple clinical reminders offered as part of the electronic data entry appear feasible and may support optimizing patient care based on guidelines and recommendations.