Myocardial infarction (MI) is a common occurrence, with an approximate annual incidence rate of 525,000 new events and 200,000 recurrent events, and an estimated 30-day mortality rate of 7.8 percent. Therefore, it is no surprise much focus and attention has been devoted to MI management. Great strides have been made in terms of improving morality and reducing morbidity via interventional techniques and advanced pharmacotherapy. However, variation exists amongst hospitals regarding MI mortality rates despite solid evidence for treatment. While geographic locations, number of beds and MI volumes have correlations with mortality rates and may explain some variability; there still remains a substantial proportion of unaccounted variation. In order to address these unknowns, investigators preformed an analysis of hospitals with the lowest 30-day risk standardized mortality rates. They found seven strategies that impacted their morality outcomes with one of the domains including pharmacist care. This analysis has blossomed into the concept of the ACC’s Surviving MI Initiative.
This outstanding initiative has come to further highlight the benefit and integral need for clinical pharmacists to be engrained in the management of all MI patients across the entire spectrum of care. Through a variety of efforts (see the below table or check out the toolkit here), clinical pharmacists can utilize their unique skills and advanced knowledge of pharmacotherapy, physical assessment and education to lead to positive outcomes. Data suggest pharmacists increase utilization of evidence-based therapies at proper doses and reduce medication errors and adverse events. These actions translate into reduced mortality, 30-day readmissions, increased medication adherence and diminished complications. Furthermore, the presences of clinical pharmacists can lead to economic gains via cost savings and cost avoidance.
Given the rising focus on value-based health care and ever increasing complexity of cardiac disease management and patients, hospitals and physicians more than ever need to maximize resources to their full potential. With the growing support for team-based care and initiatives like Surviving MI, now is the time to begin the process of working to develop effective models which include advanced clinical pharmacists in the continuum of care for MI patients. Cardiovascular service line administrators, medical directors, pharmacy administrators and practitioners should have active discussions regarding strategies for inclusion and optimization of pharmacists in the care of cardiovascular patients regardless of facility size or geographic location. Health care systems need to be proactive devising the means and putting plans into action for implementation of models that include competently trained pharmacists to meet this need. Now is time for a paradigm change to occur in order to maximize the outcomes of our patients.