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Recent trends in the care of patients with non-ST-segment elevation acute coronary syndromes: insights from the CRUSADE initiative.
Arch Intern Med 2006; 166(18):2027-34AI

Abstract

BACKGROUND

The extent to which national health quality improvement initiatives have altered reported treatment gaps among patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) is unknown. We sought to determine recent trends in adherence to guideline-based therapies for NSTE ACS.

METHODS

We evaluated the treatment of patients with high-risk (positive cardiac markers and/or ischemic ST-segment changes) NSTE ACS enrolled in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA (American College of Cardiology/American Heart Association) Guidelines (CRUSADE) Quality Improvement Initiative from 2002 through 2004 (a total of 113 595 patients over 11 calendar quarters). We analyzed adherence to guideline-recommended therapies, including medications used in the acute care period (<24 hours after presentation), invasive procedures, in-hospital outcomes, and discharge therapies and interventions.

RESULTS

The use of each class I guideline recommendation, as well as overall adherence to the guidelines, improved significantly (P<.001) during the study period. In the acute care setting, the use of antiplatelet agents increased by 5% and beta-blockers by 12%; at hospital discharge, the use of antiplatelet agents increased by 3% and beta-blockers by 8%. Heparin use in the acute care period increased by 6%, largely owing to a 9% increase in the use of low-molecular-weight heparin. Use of glycoprotein IIb/IIIa inhibitors in the acute care period also increased by more than 13%. At discharge, clopidogrel use increased by 22%, lipid-lowering agents by 11%, and angiotensin-converting enzyme inhibitors by 5%. While adherence improved, many patients still failed to receive 100% indicated treatments at the end of the study period.

CONCLUSIONS

During the 4 years since the initial release of the ACC/AHA guidelines for NSTE ACS, adherence to class I recommendations has significantly improved among hospitals participating in CRUSADE. Still, further improvements are needed for optimal implementation of the these guidelines.

Authors+Show Affiliations

Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27715, USA. mehta007@dcri.duke.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17030838

Citation

Mehta, Rajendra H., et al. "Recent Trends in the Care of Patients With non-ST-segment Elevation Acute Coronary Syndromes: Insights From the CRUSADE Initiative." Archives of Internal Medicine, vol. 166, no. 18, 2006, pp. 2027-34.
Mehta RH, Roe MT, Chen AY, et al. Recent trends in the care of patients with non-ST-segment elevation acute coronary syndromes: insights from the CRUSADE initiative. Arch Intern Med. 2006;166(18):2027-34.
Mehta, R. H., Roe, M. T., Chen, A. Y., Lytle, B. L., Pollack, C. V., Brindis, R. G., ... Peterson, E. D. (2006). Recent trends in the care of patients with non-ST-segment elevation acute coronary syndromes: insights from the CRUSADE initiative. Archives of Internal Medicine, 166(18), pp. 2027-34.
Mehta RH, et al. Recent Trends in the Care of Patients With non-ST-segment Elevation Acute Coronary Syndromes: Insights From the CRUSADE Initiative. Arch Intern Med. 2006 Oct 9;166(18):2027-34. PubMed PMID: 17030838.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recent trends in the care of patients with non-ST-segment elevation acute coronary syndromes: insights from the CRUSADE initiative. AU - Mehta,Rajendra H, AU - Roe,Matthew T, AU - Chen,Anita Y, AU - Lytle,Barbara L, AU - Pollack,Charles V,Jr AU - Brindis,Ralph G, AU - Smith,Sidney C,Jr AU - Harrington,Robert A, AU - Fintel,Dan, AU - Fraulo,Elizabeth S, AU - Califf,Robert M, AU - Gibler,W Brian, AU - Ohman,E Magnus, AU - Peterson,Eric D, PY - 2006/10/13/pubmed PY - 2006/11/11/medline PY - 2006/10/13/entrez SP - 2027 EP - 34 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 166 IS - 18 N2 - BACKGROUND: The extent to which national health quality improvement initiatives have altered reported treatment gaps among patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) is unknown. We sought to determine recent trends in adherence to guideline-based therapies for NSTE ACS. METHODS: We evaluated the treatment of patients with high-risk (positive cardiac markers and/or ischemic ST-segment changes) NSTE ACS enrolled in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA (American College of Cardiology/American Heart Association) Guidelines (CRUSADE) Quality Improvement Initiative from 2002 through 2004 (a total of 113 595 patients over 11 calendar quarters). We analyzed adherence to guideline-recommended therapies, including medications used in the acute care period (<24 hours after presentation), invasive procedures, in-hospital outcomes, and discharge therapies and interventions. RESULTS: The use of each class I guideline recommendation, as well as overall adherence to the guidelines, improved significantly (P<.001) during the study period. In the acute care setting, the use of antiplatelet agents increased by 5% and beta-blockers by 12%; at hospital discharge, the use of antiplatelet agents increased by 3% and beta-blockers by 8%. Heparin use in the acute care period increased by 6%, largely owing to a 9% increase in the use of low-molecular-weight heparin. Use of glycoprotein IIb/IIIa inhibitors in the acute care period also increased by more than 13%. At discharge, clopidogrel use increased by 22%, lipid-lowering agents by 11%, and angiotensin-converting enzyme inhibitors by 5%. While adherence improved, many patients still failed to receive 100% indicated treatments at the end of the study period. CONCLUSIONS: During the 4 years since the initial release of the ACC/AHA guidelines for NSTE ACS, adherence to class I recommendations has significantly improved among hospitals participating in CRUSADE. Still, further improvements are needed for optimal implementation of the these guidelines. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/17030838/Recent_trends_in_the_care_of_patients_with_non_ST_segment_elevation_acute_coronary_syndromes:_insights_from_the_CRUSADE_initiative_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.166.18.2027 DB - PRIME DP - Unbound Medicine ER -