Document Detail

Current management of acute coronary syndromes in Australia: observations from the acute coronary syndromes prospective audit.
MedLine Citation:
PMID:  17645500     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Acute coronary syndromes (ACS) management is now well informed by guidelines extrapolated from clinical trials. However, most of these data have been acquired outside the local context. We sought to describe the current patterns of ACS care in Australia. METHODS: The Acute Coronary Syndrome Prospective Audit study is a prospective multi-centre registry of ST-segment elevation myocardial infarction (STEMI), high-risk non-ST-segment elevation ACS (NSTEACS-HR) and intermediate-risk non-ST-segment elevation ACS (NSTEACS-IR) patients, involving 39 metropolitan, regional and rural sites. Data included hospital characteristics, geographic and demographic factors, risk stratification, in-hospital management including invasive services, and clinical outcomes. RESULTS: A cohort of 3402 patients was enrolled; the median age was 65.5 years. Female and non-metropolitan patients comprised 35.5% and 23.9% of the population, respectively. At enrolment, 756 (22.2%) were STEMI patients, 1948 (57.3%) were high-risk NSTEACS patients and 698 (20.5%) were intermediate-risk NSTEACS patients. Evidence-based therapies and invasive management use were highest among suspected STEMI patients compared with other strata (angiography: STEMI 89%, NSTEACS-HR 54%, NSTEACS-IR 34%, P < 0.001) (percutaneous coronary intervention: STEMI 68.1%, NSTEACS-HR 22.2%, NSTEACS-IR 8.1%, P < 0.001). In hospital mortality was low (STEMI 4.0%, NSTEACS-HR 1.8%, NSTEACS-IR 0.1%, P < 0.001), as was recurrent MI (STEMI 2.4%, NSTEACS-HR: 2.8%, NSTEACS-IR 1.2%, P = 0.052). CONCLUSION: There appears to be an 'evidence-practice gap' in the management of ACS, but this is not matched by an increased risk of in-hospital clinical events. Objective evaluation of local clinical care is a key initial step in developing quality improvement initiatives and this study provides a basis for the improvement in ACS management in Australia.
D P Chew; J Amerena; S Coverdale; J Rankin; C Astley; D Brieger
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-07-23
Journal Detail:
Title:  Internal medicine journal     Volume:  37     ISSN:  1445-5994     ISO Abbreviation:  Intern Med J     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-10-02     Completed Date:  2007-10-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  101092952     Medline TA:  Intern Med J     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  741-8     Citation Subset:  IM    
Department of Cardiology, Flinders University, Flinders Medical Centre, Adelaide, South Australia.
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MeSH Terms
Angina, Unstable / therapy*
Cohort Studies
Delivery of Health Care*
Evidence-Based Medicine
Guideline Adherence
Heart Conduction System
Medical Audit
Myocardial Infarction / therapy*
Practice Guidelines as Topic
Rural Population
Severity of Illness Index
Urban Population
Comment In:
Intern Med J. 2007 Nov;37(11):737-8   [PMID:  17908084 ]

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