Secondary prevention for coronary artery disease: are we following the guidelines?

Secondary prevention pharmacotherapy in post-myocardial infarction (MI) patients reduces the risk of subsequent coronary events and overall mortality. International guidelines recommend use of aspirin, beta-blockers, ACE inhibitors and statins in post-MI patients. We performed this audit to review the compliance of prescribing practices, in a regional hospital in Ireland, with international guidelines for secondary prevention of coronary artery disease. We performed a retrospective case review of 172 patients diagnosed with MI during a 1-year period between January and December 2007. A total of 134 patients fulfilled the inclusion criteria. On discharge, aspirin was prescribed to 131 (97.76%) patients, clopidogrel to 126 (94%), beta-blockers to 117 (87%), ACE inhibitor to 87 (65%), ARB to 10 (7%) and statins to 116 (87%). Our audit shows that targets for prescription of secondary prevention medications were not met in a small but significant proportion of patients and calls for review of discharge practices and education to improve compliance with guidelines.