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

Abstract

Background: Although 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. Objective: The 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. Method: A 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. Results: During 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%). Conclusion: The post-PCI clinic led to a higher usage rate of secondary prevention medications compared with historical controls.