Establishment of post‐percutaneous coronary intervention (post‐PCI) clinic in Thailand

Abstract

BackgroundAlthough significant advancements have been made in the acute management of acute coronary syndrome (ACS) in Thailand, there is a need for improvement in the longitudinal care post cardiac stenting.ObjectiveThe study aimed to describe the successful establishment of the first post‐percutaneous coronary intervention (PCI) clinic in Thailand and its preliminary impact compared with historical controls.MethodA multidisciplinary outpatient clinic entitled the “post‐PCI clinic,” consisting of cardiologists, nurses, clinical pharmacists, a physical therapist, and a dietitian, was established in 2016 to provide longitudinal care for patients who underwent cardiac stenting at a tertiary care hospital. A standard care pathway, along with the clinic's standard operating protocols, was designed and implemented. A pre‐post intervention, quasi‐experimental study, was conducted to compare the usage rate of secondary prevention medications between patients enrolled in the post‐PCI clinic (January–April 2016) and historical controls (January–June 2015) at month 6 after hospital discharge.ResultsDuring January–April 2016, 91 patients were enrolled in the post‐PCI clinic, with a mean age of 59.2 ± 11.9 years and 65.9% being male. Of these patients, 94.5% presented with ST‐segment elevation myocardial infarction. Regarding the PCI procedure, 90.1% underwent primary PCI, and 9.9% underwent elective PCI. Almost all patients (98.9%) received drug‐eluting stent placement, except for one. Compared with the historical control group, the usage rates of Angiotensin‐converting enzyme (ACE) inhibitors/Angiotensin Receptor Blockers (ACEIs/ARBs) (94.5% vs. 76.5%; p < 0.001), beta‐blockers (93.4% vs. 81.4%; p = 0.013), and high‐intensity statins (90.1% vs. 33.3%; p < 0.001) were higher in the post‐PCI clinic group 6 months after discharge. The three most common interventions by clinical pharmacists were recommendations to initiate new therapy (52.4%), suggestions to adjust dosage regimen (36.7%) and suggestions to change therapy (10.9%).ConclusionThe post‐PCI clinic led to a higher usage rate of secondary prevention medications compared with historical controls.