Lappé J M et al. (2004) Improvements in 1-year cardiovascular clinical outcomes associated with a hospital-based discharge medication program. Ann Intern Med. 141: 446–453

Despite a wealth of evidence supporting the use of medical therapies in the secondary prevention of cardiovascular disorders, many patients are discharged from hospital without the appropriate medications. Lappé and colleagues have attempted to bridge this treatment gap by designing a 'discharge medication program' (DMP).

This quality-improvement initiative, implemented in 1999, covered 10 hospitals of Intermountain Health Care in the US. The aim was to ensure the appropriate prescription of evidence-based medications (aspirin, statins, [beta]-blockers, ACE inhibitors and warfarin) at discharge. To this end, the patient discharge form was amended to show the indications for each medication. Physicians were required to check the appropriate box on the form, or to note any contraindication. Tracking of discharge medication data began the year before implementation of the DMP and is ongoing.

One year after the DMP began, prescription rates for each of the targeted medications had increased significantly, reaching 90% of appropriate patients. At 30 days' follow-up, the relative risk of death and readmission was significantly lower for patients in the DMP period (n = 31,465) than for those admitted before the DMP was implemented (n = 26,000). The risk of death continued to decrease significantly in the DMP group at 1 year, although the risk of readmission remained stable.

Lappé et al. conclude that the DMP was feasible and sustainable in this multihospital setting. Importantly, this approach might improve long-term cardiovascular readmission rates and mortality at low cost.