All of the researchers at Intermountain Healthcare are practicing clinicians, which isn’t always the case with researchers in many health care institutions. This unique setting allows researchers to identify questions firsthand as they interact with patients and seek to provide the best evidence-based care.
“Our questions typically arise from concerns we have in the treatment of our patients,” said Brent Muhlestein, MD, co-director of research at the Intermountain Medical Center Heart Institute. “We then design a study to find the answer, and based on the results, change our practice patterns by setting up guidelines and medical management processes backed by that research.”
Back in the early 1990s, before the American Heart Association’s Get with the Guidelines existed, there were no evidence-based guidelines for patients with heart disease and medications. For example, patients with coronary artery disease were not necessarily being discharged on a statin, because there was an understanding that patients needed to be further evaluated to determine the need for statins.
Dr. Muhlestein and his colleagues decided to ask the question about how important it is for patients to be placed on a statin at the time of discharge with coronary artery disease diagnosis.
“In this particular study, the patients who did not receive discharge medications did not do as well as the patients who were provided with secondary prevention medications upon discharge,” said Dr. Muhlestein. “Once we discovered that, we developed and implemented discharge medication protocols to assure as many patients as possible were discharged on the appropriate medications We then documented a significant reduction in repeat hospitalizations and death in the pre- and post-groups studied."
The results from this study were published in the Archives of Internal Medicine soon after. This information, along with other published data, was later utilized by national groups to improve heart care by developing the national Get with the Guidelines program.
“You take questions that are clinically relevant, you answer the question, change your clinical practice based on that, then publish it so the rest of the world can benefit from the information as well,” said Dr Muhlestein.
The research presented at the 2014 American Heart Association Scientific Sessions will help improve patient care as it’s applied to the clinical practice.