Role of the cardiology pharmacist in improving quality of care for patients with acute myocardial infarction based on ESC-ACCA quality indicators

Abstract Background The European Society of Cardiology-Acute Cardiovascular Care Association (ESC-ACCA) suggested the use of quality indicators (QIs) to improve quality of care for patients with acute myocardial infarction (AMI). Among these QIs are prescribing of angiotensin-converting enzyme inhibitor (ACEi) and beta blocker (BB) if left ventricular ejection fraction (LVEF) was ≤40%, and prescribing high intensity statin and dual antiplatelet therapy (DAPT) before discharging patients from the coronary care unit (CCU). Purpose To identify the role of cardiology clinical pharmacy specialist in improving quality of care for patients with AMI based on ESC-ACCA QIs. Methods A cross-sectional study was conducted at a single CCU in Iraq between January 2021 and August 2023. Patients with AMI with or without LVEF ≤40% were included in the study. Patients' profiles were reviewed to collect data about suggestions by the cardiology clinical pharmacy specialist to initiate high intensity statin, addition of a second antiplatelet therapy to keep patients on DAPT, or addition of ACEi and/or BB if LVEF ≤40%. Results Total number of patients included was 326 of whom 119 (37%) patients had LVEF ≤40%. Drug interventions by the cardiology clinical pharmacy specialist with the initiation of statin and addition of a second antiplatelet therapy to optimize DAPT for patients with AMI and initiation of ACEi and/or BB for patients with AMI and LVEF ≤40% are shown in table 1 and figure 1. Drug interventions were based on the updated ESC guidelines and agreed by the interventional cardiologists. Conclusions Role of the cardiology clinical pharmacy specialist was important in bridging gaps in the medical therapy and improving quality of care for patients with AMI and/or LVEF ≤40% by optimizing patients medications particularly for the initiation of ACEi. ACEi was initiated in about one-quarter of the patients with AMI and LVEF ≤40% based on the suggestion of the cardiology clinical pharmacy specialist and approved by the interventional cardiologists.