The University Record, April 2, 2001

Discharge program found to empower, educate patients with heart conditions

By Valerie Gliem
Health System Public Relations

A U-M study of patients with heart conditions shows that the U-M’s discharge program is having a favorable effect, especially with patients maintaining key medications. Included in the program is a discharge form that ensures that patients understand that they have had a heart attack, what that means, what medications should be taken and why. Photo by Martin Vloet, U-M Photo Services
For patients with heart conditions, medication can mean the difference between running a mile and racing to the emergency room.

Studies have shown that beta blockers, aspirin, lipid-lowering agents and other medications decrease patient morbidity and mortality after heart attacks and episodes of unstable angina.

But little data exists to show whether people with these heart problems continue to take their medications after hospital discharge.

Researchers at the Health System studied how well patients who had suffered heart attacks or unstable angina complied with their doctors’ recommendations about medications after leaving the hospital. Results suggest that the U-M’s approach to patient education at discharge is having a favorable effect. The research was presented recently at the annual Scientific Session of the American College of Cardiology.

“Very little information is known about whether patients continue to take their post-heart attack or angina medications six months after discharge from the hospital,” says Eva Kline-Rogers, nurse practitioner, cardiovascular outcomes research coordinator and the study’s principal investigator. “This is one of the only reports that’s ever been published that examines whether patients are maintaining their medications. It suggests that the program used at U-M to educate patients about their conditions and the need for medications is very effective.”

Researchers followed 409 patients with acute coronary syndromes. Of those patients, 113 had ST-segment elevation myocardial infarctions or severe heart attacks causing significant heart damage; 108 had non-ST-segment elevation myocardial infarctions, which are generally less severe and produce less significant heart damage; and 188 had unstable angina. Angina is a severe, squeezing pain in the chest caused by reduced oxygen to the heart from poor blood supply.

Just before these patients were discharged, each went through the U-M’s discharge program. The program includes a form that has been used for more than four years and is now one facet of a nationwide study called the GAP Initiative—Guidelines Applied in Practice Initiative. GAP is sponsored by the American Association of Cardiology and led by principal investigator Kim Eagle, chief of cardiology and co-director of the Cardiovascular Center.

The discharge form ensures that patients understand that they have had a heart attack, what that means, what medications should be taken and why. Medications may include aspirin, ACE inhibitors, beta blockers and lipid-lowering agents. If a patient smokes or has a high-fat diet, the form indicates that the individual has been counseled to stop smoking and to follow a heart-healthy diet. Both the patient and the doctor or nurse sign the form once all of the patient’s questions are answered.

Although the form does not address unstable angina, patients with that condition were discharged using a similar process.

Six months after discharge, the researchers made at least five attempts to reach all heart attack and unstable angina patients. They were asked various questions, including what medications they were taking.

“Although we know there’s still room to improve, we were pleasantly surprised,” Kline-Rogers says. “Because of the discharge procedures, our compliance rate with key treatments is high at discharge. This study shows that our compliance rate remains high six months after discharge. That’s vitally important, because we know that these therapies reduce mortality and morbidity over the long term in patients who’ve suffered acute coronary syndromes.”

Before discharge, physicians evaluated appropriate therapies for all patients and individualized follow-up medications.

For patients in the study with ST-segment elevation myocardial infarction, doctors recommended that 97.2 percent take aspirin. At six months, 90.3 percent of these patients still were taking aspirin. Other recommended medications and compliance rates include: beta blockers—85.8 percent at discharge, 81.1 percent at follow up; ACE inhibitors—72.6 percent, 59.4 percent; lipid-lowering agents—67.3 percent, 71.7 percent.

The follow-up results for patients with non-ST-segment elevation myocardial infarction and unstable angina were similarly impressive.

Kline-Rogers points out that the results were not corrected for contraindications—when patients were advised not to take a medication because of their medical histories or medical conditions.

“This study suggests that patient education and empowerment, along with direct communication with the patient’s primary physician at the time of discharge as well as a focus on goals for long-term management, improves patients’ compliance with strategies that prolong life,” Kline-Rogers says.

Other researchers on the project were: Eagle; Rajendra H. Mehta, clinical assistant professor of cardiology; Akhil Gulati, Heart Care Program; Obli C.M. Mani, research fellow, Department of Internal Medicine; Deepak Venkat, Heart Care Program; Jeanna V. Cooper, research associate, Department of Internal Medicine; Gwen E. Kearly, clinical nurse supervisor; Elizabeth Nolan, clinical nurse specialist; Robert J. Cody, professor of internal medicine; and Steven R. Erickson, assistant professor, College of Pharmacy.