Document Detail

Comparative trends in guidelines adherence among patients with non-ST-segment elevation acute coronary syndromes treated with invasive versus conservative management strategies: Results from the CRUSADE quality improvement initiative.
MedLine Citation:
PMID:  19853692     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Prior studies have demonstrated differences in adherence to non-ST-segment elevation acute coronary syndromes (NSTE ACS) guidelines-recommended therapies among patients managed conservatively without cardiac catheterization compared with those managed invasively. We evaluated the degree of yearly change in use of guidelines-recommended therapies for patients with NSTE ACS in CRUSADE stratified by use of cardiac catheterization and revascularization procedures. METHODS: We analyzed data from 138,714 high-risk patients with NSTE ACS treated at 547 hospitals during the first 4 years of the CRUSADE initiative. Patients were categorized as no cardiac catheterization (29% of the total population), cardiac catheterization without revascularization (21%), percutaneous coronary intervention (40%), and coronary artery bypass graft surgery (11%). Composite guidelines adherence scores were used to compare yearly changes in use of guidelines-recommended therapies among the groups. RESULTS: Although guidelines adherence improved in all 4 groups each year and was consistently highest in the percutaneous coronary intervention group, the adjusted yearly increase in the use of acute guidelines-recommended medications was highest in the no cardiac catheterization group, and the adjusted yearly increase in the use of discharge medications was highest in the coronary artery bypass graft surgery group. CONCLUSIONS: Improvements in the use of guidelines-recommended therapies were seen among all patients with NSTE ACS in CRUSADE over a 4-year period regardless of management strategy, and the trajectory of improvement in acute care was greatest in patients managed conservatively.
Ezra A Amsterdam; Eric D Peterson; Fang-Shu Ou; L Kristin Newby; Charles V Pollack; W Brian Gibler; E Magnus Ohman; Matthew T Roe
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  158     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-26     Completed Date:  2009-12-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  748-754.e1     Citation Subset:  AIM; IM    
University of California-Davis, USA.
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MeSH Terms
Acute Coronary Syndrome / diagnosis,  therapy*
Databases as Topic
Guideline Adherence*
Heart Catheterization
Practice Guidelines as Topic*

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