Use of Ramipril

Audit date

2000-2001

Target population

Patients with cardiovascular and diabetic disease

Method

The Primary Health Care Team will start to implement the Heart Outcomes Prevention Evaluation (HOPE) study, together with the Micro-Hope study. This study presented at the 21st Congress of the European Society of Cardiology produced striking results in cardiovascular and diabetic patients treated with ACE-inhibitor Ramipril.

Results:

	HOPE	MICRO-HOPE
Cardiovascular death reduced	26%	37%
MI reduced	29%	22%
Stroke reduced	32%	33%

Evidence suggests this has added benefits to the above

Reduction in revascularisation procedures 15%
Reduction in hospitalisation for heart failure 16%

Cycle 1

Focus	Steps to be taken	Targets	Time scale	Resources	Success criteria
Cardio-vascular patients Diabetic patients	identify opportunistic screening computer search	Prescribe ramipril	12 months from April 2001	Dr / Nurse / Secretarial time	Computer search in April 2002 to ascertain percentage who have been prescribed ramipril

A computer marker "Consider Ramipril" will be actioned
Initially opportunistic screening will be used as a tool for identification
A 3 monthly Computer search will identify those patients not on RAMIPRIL
Each doctor/nurse/health worker to decide if treatment suitable
Analysis of results by Practice Team at end of cycle, to include possible
- Reduction CVS events
- Reduction in morbidity

Cycle 2003

Audit date

December 2003

Target population

Patients with cardiovascular and diabetic disease

Why

Results

	HOPE	MICRO-HOPE
Cardiovascular death reduced	26%	37%
MI reduced	29%	22%
Stroke reduced	32%	33%

Evidence suggests this has added benefits to the above

Reduction in revascularisation procedures 15%
Reduction in hospitalisation for heart failure 16%
No patients with read code IHD 971
No patients with IHD on Ramipril 132 = 13%
No Patients with read code Diabetes 446
No patients Diabetes on Ramipril 106 =23%

Comment

Both groups especially IHD should have higher uptake ACE inhibitors
Diabetic group probably doing quite well as many will be diet controlled

Brent Smith

Logo Brad Cheek 2000

Brad Cheek: last updated Dec 2006
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