Myocardial Infarction and Acute Coronary Syndrome (MI&ACS)
The guidance includes such things as dietary advice, exercise advice and referral to cardiac rehabilitation, smoking advice and the use of specific drugs. One area that many PCTs have an interest in is the appropriate use of Clopidogrel, an expensive drug used for varying lengths of time after an infarct. The audit will enable practices to see that they are using it in accordance with the guidance.
The audit includes all patients who have had any Acute Coronary Syndrome, not just an MI. All these patients are at higher risk. Review of them may reveal some with an MI, which has not been recorded as such, or some where there is in fact no Cardiac cause and the addition of the Acute Coronary Syndrome code (G3115) has entered them on the CHD register.
The audit also looks at the way in which MIs are coded by the practice. Secondary care is now discharging them with a diagnosis of either STEMI or NSTEMI, but is this being recorded? The risks and the management of the two differ and where the information is available it should be recorded.