Implementing a pathway for the management of acute coronary syndrome leads to improved compliance with guidelines and a decrease in angina symptoms

J Healthc Qual. Jul-Aug 2012;34(4):5-14. doi: 10.1111/j.1945-1474.2011.00145.x. Epub 2011 Jun 2.


We describe our experience with the Advanced Cardiac Admission Program (ACAP) at our institution. The ACAP program is a hospital-wide implementation of critical pathways-based management of all cardiac patients. Data review of patients admitted for acute coronary syndromes from the ACAP-PAIN database and a comparative study of outcomes before and after implementation of the pathways-based assessment and treatment protocols. In the pre-ACAP and post-ACAP patient groups, antiplatelet use at admission improved from 50% to 75% (p<.01), ACE-I use improved from 32% to 54% (p<.0001), statins use increased from 35% to 62% (p<.0001), and smoking cessation awareness increased from 15% to 86% (p<.0001). At 1-year follow-up, 84% of patients with CAD were treated with statins, and 47% had LDL cholesterol <100 mg/dL, compared with 20% and 9%, respectively, with conventional treatment before ACAP implementation (p<.0001). Recurrent angina symptoms and nonfatal myocardial infarction rates decreased from 28.5% to 13% (p = .02), and 15% to 5% (p = 0.03), respectively. Pathway-based programs like ACAP significantly enhance administration of guidelines-based cardioprotective medications both during hospital stay and at 1-year follow-up.

MeSH terms

  • Acute Coronary Syndrome / drug therapy*
  • Adult
  • Aged
  • Cardiotonic Agents / therapeutic use*
  • Critical Pathways / organization & administration*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Medication Adherence / statistics & numerical data*
  • Middle Aged
  • Practice Guidelines as Topic
  • Program Evaluation
  • Quality Assurance, Health Care*
  • Treatment Outcome


  • Cardiotonic Agents