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 Jjournal_title
American heart journalauthors
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 EMdoi
10.1016/j.ahj.2005.08.006subject
Has Abstractpub_date
2006-06-01 00:00:00pages
1205-13issue
6eissn
0002-8703issn
1097-6744pii
S0002-8703(05)00788-Xjournal_volume
151pub_type
杂志文章abstract::To determine the prevalence and significance of exercise-induced localized perfusion defects in symptomatic patients with aortic valve disease, thallium-201 rest and exercise studies were performed in a consecutive series of 29 such patients prior to left heart catheterization with coronary arteriography. Eight patien...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(82)90535-x
更新日期:1982-01-01 00:00:00
abstract:BACKGROUND:Knowledge of pressure gradients across valves, arteries, and ventricular septal defects (VSD) is important in patient management. It was determined how well such gradients can be estimated by auscultation of a murmur's frequencies. METHODS:In 151 patients with pulmonary stenosis (PS) (n = 77), aortic stenos...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2001.113222
更新日期:2001-03-01 00:00:00
abstract::Histological study of the sinoatrial node (SAN) was performed in 111 patients in order to estabilsh correlations between the ECG findings and the anatomical lesions. This series includes both patients with sinus rhythm and patients with atrial arrhythmias. The results are as fololows: (a) the amount of nodal cells in ...
journal_title:American heart journal
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更新日期:1977-06-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(76)80010-5
更新日期:1976-12-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(05)80086-9
更新日期:1990-01-01 00:00:00
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更新日期:2005-01-01 00:00:00
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pub_type: 杂志文章
doi:10.1016/0002-8703(95)90232-5
更新日期:1995-07-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2017-02-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:1992-04-01 00:00:00
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更新日期:2002-08-01 00:00:00
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journal_title:American heart journal
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更新日期:2006-02-01 00:00:00
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journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:2003-02-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:1999-04-01 00:00:00
abstract::The effects and possible mechanisms of actions of indomethacin on systemic and coronary hemodynamics were studied in 17 patients with coronary artery disease. Group I patients (12) were given either indomethacin or placebo in the absence of prior cyclooxygenase inhibition and group II (five) were given indomethacin af...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
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更新日期:1985-08-01 00:00:00
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journal_title:American heart journal
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doi:10.1016/s0002-8703(77)80246-9
更新日期:1977-03-01 00:00:00
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journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1992-04-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2009.12.045
更新日期:2010-05-01 00:00:00
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pub_type: 杂志文章
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更新日期:2010-04-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2020-04-01 00:00:00
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pub_type: 临床试验,杂志文章
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更新日期:1981-05-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2009-05-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
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更新日期:2004-12-01 00:00:00
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journal_title:American heart journal
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更新日期:2005-10-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
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更新日期:1976-02-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
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更新日期:1989-12-01 00:00:00
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pub_type: 杂志文章
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更新日期:1991-08-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
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更新日期:2004-01-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
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更新日期:1988-01-01 00:00:00
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journal_title:American heart journal
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更新日期:2007-04-01 00:00:00