Improvements in 1-Year Outcomes before and after a Discharge Medication Program for Patients Hospitalized with Heart Disease

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The summary below is from the full report titled "Improvements in 1-Year Cardiovascular Clinical Outcomes Associated with a Hospital-Based Discharge Medication Program." It is in the 21 September 2004 issue of Annals of Internal Medicine (volume 141, pages 446-453). The authors are J.M. Lappé, J.B. Muhlestein, D.L. Lappé, R.S. Badger, T.L. Bair, R. Brockman, T.K. French, L.C. Hofmann, B.D. Horne, S. Kralick-Goldberg, N. Nicponski, J.A. Orton, R.R. Pearson, D.G. Renlund, H. Rimmasch, C. Roberts, and J.L. Anderson.

What is the problem and what is known about it so far?

Research shows that many drugs improve outcomes for patients with heart disease. Unfortunately, many patients with heart disease who could benefit from these drugs do not receive them. In addition, among patients who do receive the drugs, many do not take them the way they should. It is possible that patients are more likely to take drugs and to take them the right way if they get the drug prescription at the end of a hospitalization.

Why did the researchers do this particular study?

To find a way to increase the prescription of appropriate drugs after hospitalization for heart disease. The researchers also wanted to see if there was any relationship between improved prescription at the time of hospital discharge and patients' health after leaving the hospital.

Who was studied?

57,465 patients hospitalized with heart problems in 10 hospitals in Utah and Idaho over 6 years.

How was the study done?

The researchers changed a standard hospital discharge form to remind doctors to think about prescribing certain drugs to patients with heart disease who were being sent home from the hospital. The researchers then compared the numbers of patients who got prescriptions for the drugs in the 3 years before the change and the 3 years afterward. They also compared what happened to the 2 groups of patients to see how many died or needed to come back to the hospital for a heart problem during the following year.

What did the researchers find?

More patients received appropriate prescriptions during the 3 years after the form was changed than during the 3 years before the change. After the change, fewer patients died or had to come back to the hospital for heart problems within a year of being sent home.

What are the limitations of the study?

The observed improvements may have been due to general improvements in the care of patients with heart disease over time rather than to the new hospital discharge form. Also, the researchers did not have the complete information on each patient that would have allowed them to find other possible explanations for the improvements.

What are the implications of the study?

A simple change to a standard hospital form is an inexpensive and potentially effective way for hospitals to ensure that patients with heart disease leave the hospital while taking appropriate drugs.