Early use of glycoprotein IIb/IIIa inhibitors in the ED treatment of non-ST-segment elevation acute coronary syndromes: a local quality improvement initiative

• Published in: The American journal of emergency medicine 2003-07, Vol.21 (4), p.302-308
• Main Authors: Fesmire, Francis M, Peterson, Eric D, Roe, Matthew T, Wojcik, James F
• Format: Article
• Language: English
• Subjects: acute coronary syndrome; Acute coronary syndromes; acute myocardial infarction; Angina pectoris; Angioplasty; Anticoagulants - therapeutic use; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Coronary Disease - drug therapy; Coronary Disease - physiopathology; Coronary vessels; Education; Electrocardiography; Emergency medical care; Emergency Medical Services; Female; glycoprotein IIb/IIIa inhibitors; Health care; Heart attacks; Humans; Inhibitors; Male; Medical sciences; Middle Aged; Observational studies; Pain; Pharmacology. Drug treatments; Physicians; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Prospective Studies; Quality improvement
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/S0735-6757(03)00027-5

A prospective observational study was conducted in 2,007 patients experiencing chest pain to determine impact of local quality improvement (QI) measures on the use of glycoprotein (GP) IIb/IIIa inhibitors in the ED treatment of high-risk patients with non-ST-segment elevation acute coronary syndromes (ACS). Patients with injury on the initial ECG or new sustained injury on continuous ECG were excluded. QI interventions were as follows: control (0-4 mo): no interventions (standardized protocols and prewritten orders in place 4 months prior); phase I (5-8 mo): simple education/awareness program with posted drug information pamphlets and eligibility criteria; phase II (9-12 mo): mandated QI form with real-time feedback and focused one-on-one physician education championed by an ED physician QI advocate. A total of 179 (8.9%) of the study patients met predefined high-risk criteria. Of these, a total of 41 (23.0%) patients had GP IIb/IIIa inhibitor therapy initiated in the ED. Percent of high-risk patients receiving therapy increased from 6.0% during the control phase to 16.1% during phase I and 50.9% during phase II. After controlling for patient demographics, patients treated during phase I had a 2.8 times increased odds (95% confidence interval CI: 0.8-10.3; P = .11 [not significant]) of receiving GP IIb/IIIa inhibitor relative to the control phase, and patients treated during phase II had a 20.2 times increased odds (95% CI: 6.1-66.9; P