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POST-MI - RxFiles
post -MITroubleshooting Practical IssuesOctober 2004 The RxFiles Academic Detailing Programin collaboration withDerek Jorgenson, Health Quality Council (HQC)701 Queen StreetSaskatoon City HospitalSaskatoon, SK S7K 0M7 Phone 306-655-8506 ; Fax 306-655-7980 Email: Message: Four types of medication (ACE-Inhibitors, beta-blockers,statins & ASA) have been shown to reduce cardiovascularrisk in POST-MI patients. 1 These benefits are in addition torisk factor management (eg. diet 2,3,4, lifestyle, exercise) andoccur regardless of the presence of hypertension,dyslipidemia, or LV dysfunction. Clinical judgment isessential to assess risk/benefit for individual are we doing in Saskatchewan? An analysis of Saskatchewan dispensing rates by the HQCsuggests that important drugs are underutilized (See Figure 1).PRACTICAL ISSUES ACE Inhibitors (ACEI)Which patients will benefit? All post MI patients without contraindications 1 (indefinitely) Shown to reduce risk of CV events in POST-MI patients whoare high risk 5,6,7 (elderly, LV dysfunction); some benefit alsoin lower risk 8,9 patients ( young, no LV dysfunction) Beneficial when initiated soon after acute MI 1 (~first 24hrs) AHA 04 Initiation & dosing in patients with renal dysfunction 10 Ensure SCr is stable before initiating ACEI therapy Start with low doses, slowly titrating towards targets with closemonitoring.
POST-MI Troubleshooting Practical Issues October 2004 The RxFiles Academic Detailing Program in collaboration with Derek Jorgenson, Health Quality Council (HQC)
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