249 Quality of Preventive Care Prior to a First Myocardial Infarction

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Significant improvement has been made in the quality of care for acute myocardial infarctions (MI). However, little is known about the quality of preventive care received by patients prior to their first MI. The aim of this study was to determine the screening rates for diabetes and hyperlipidemia prior to a patient's first MI. Furthermore, we determined the rate of missed opportunities where patients were seen by their primary care physician but not screened for diabetes or hyperlipidemia. We conducted a retrospective, population-based cohort analysis of 5,688 patients admitted with their first MI to 96 acute care hospitals in Ontario, Canada, from April 2004 to March 2005 using the Enhanced Feedback For Effective Cardiac Treatment (EFFECT) clinical study database (ClinicalTrials.Gov Identifier: NCT00187460). We calculated rates of screening for diabetes and hyperlipidemia according to the Canadian Diabetes Association Guidelines and the Canadian Cardiovascular Society Dyslipidemia Guidelines, respectively. The number of primary care visits in the last five years was also calculated. Screening rates were stratified by age, gender, socioeconomic status and number of primary care visits in the last five years. Among the 5,688 eligible patients, 27.1% did not receive serum cholesterol screening in the five years preceding their MI and 27.5% of patients did not receive a fasting blood glucose or glucose tolerance test in the three years prior to their MI. Women were more likely to be screened than men. Screening rates increased with age and were similar across socio-economic categories. More than 95% of patients with their first MI had at least one primary care visit in the last five years. There was a positive association between the number of primary care visits and the likelihood of being screened for diabetes and hyperlipidemia. A significant number of patients admitted with their first MI were not screened for important modifiable risk factors. Many opportunities for the prevention of coronary disease are being missed and more emphasis is needed on identifying risk factors prior to the development of acute coronary disease. Missed opportunities should alert policy makers that additional tools or incentives are needed to ensure that we are screening patients.