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

Ezra A. Amsterdam, Eric D. Peterson, Fang-Shu Ou, L. Kristin Newby, Charles V. Pollack, W. Brian Gibler, E. Magnus Ohman, Matthew T. Roe

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Abstract

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.

Original languageEnglish (US)
JournalAmerican Heart Journal
Volume158
Issue number5
DOIs
StatePublished - Nov 1 2009
Externally publishedYes

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Guideline Adherence
Acute Coronary Syndrome
Quality Improvement
Cardiac Catheterization
Guidelines
Percutaneous Coronary Intervention
Coronary Artery Bypass
Transplants
Group Psychotherapy
Conservative Treatment
Therapeutics
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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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. / Amsterdam, Ezra A.; Peterson, Eric D.; Ou, Fang-Shu; Newby, L. Kristin; Pollack, Charles V.; Gibler, W. Brian; Ohman, E. Magnus; Roe, Matthew T.

In: American Heart Journal, Vol. 158, No. 5, 01.11.2009.

Research output: Contribution to journalArticle

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abstract = "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.",
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AU - Ou, Fang-Shu

AU - Newby, L. Kristin

AU - Pollack, Charles V.

AU - Gibler, W. Brian

AU - Ohman, E. Magnus

AU - Roe, Matthew T.

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