A Hybrid Chart Review of Premature Coronary Artery Disease: An Opportunity to Improve Diagnostic Excellence and Management.

Background: Premature coronary artery disease (premCAD) and its risk factors may not always be diagnosed or treated optimally.

Objective: This study reviewed a sample of patients with premCAD within an integrated health care system to identify opportunities for improved diagnosis and care.

Design: Retrospective chart review.

Participants: The authors reviewed a sample of 28 patients with acute myocardial infarction before age 50.

Key results: Several opportunities were found, including lack of documentation of family history of premCAD (only present in 5/28 [18%]); delays or failure to diagnose in electronic chart problem in patients with diabetes mellitus (3/15 [20%]); failure to diagnose obesity in patients with a body mass index > 30 (12/28 [43%]); and gaps in continuity of care in patients who were new members (3/28 [11%]). These findings led to several changes, including improved identification and monitoring of patients with possible diabetes mellitus and obesity; improved identification of patients with increased risk of premCAD; and improved identification of premCAD risk factors in newly enrolled members.

Conclusions: This study highlights the value of a systematic approach to identifying variability and in developing tailored strategies to improve the diagnosis and management of premCAD and reduce future incidence. This approach can be used in other settings and conditions to identify areas for system improvement.