The influence of risk status on guideline adherence for patients with non-ST-segment elevation acute coronary syndromes.

Abstract:

BACKGROUND:Practice guidelines for patients with non-ST-segment elevation (NSTE) acute coronary syndromes (ACS) recommend targeting evidence-based therapies for the highest-risk patients. We characterized guideline adherence for NSTE ACS by risk status. METHODS:We analyzed inhospital treatments and outcomes for 77760 patients with NSTE ACS (ischemic ST-segment changes and/or positive cardiac markers) included in the CRUSADE initiative from January 2001 to September 2003 at 457 US hospitals. Compliance with the American College of Cardiology/American Heart Association Class guideline recommendations for NSTE ACS was evaluated in subgroups of eligible patients without listed contraindications at increased risk for mortality and among risk categories designated by an adapted version of the PURSUIT risk model designed to predict inhospital mortality. RESULTS:Inhospital mortality was increased in patients with diabetes mellitus (5.8% vs 4.3%), renal insufficiency (10.0% vs 3.9%), signs of congestive heart failure on presentation (10.6% vs 3.1%), and age > or = 75 years (8.6% vs 2.7%), compared with patients without these features. Use of guideline-recommended acute medications, invasive cardiac procedures, and discharge medications and interventions was significantly lower in patients with these high-risk features. Patients designated as high-risk for inhospital mortality were less likely to be treated with guideline-recommended therapies compared with low-risk and moderate-risk patients. CONCLUSIONS:Patients with NSTE ACS with the highest risk of mortality are less likely to receive guideline-recommended therapies and interventions. These findings highlight the need to clarify guideline recommendations for high-risk patients and to develop novel quality improvement approaches that target undertreated subgroups of patients with NSTE ACS.

journal_name

Am Heart J

journal_title

American heart journal

authors

Roe MT,Peterson ED,Newby LK,Chen AY,Pollack CV Jr,Brindis RG,Harrington RA,Christenson RH,Smith SC Jr,Califf RM,Braunwald E,Gibler WB,Ohman EM

doi

10.1016/j.ahj.2005.08.006

subject

Has Abstract

pub_date

2006-06-01 00:00:00

pages

1205-13

issue

6

eissn

0002-8703

issn

1097-6744

pii

S0002-8703(05)00788-X

journal_volume

151

pub_type

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