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.
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 AnginaPatients 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: Sana M Al-Khatib; Anne S Hellkamp; Adrian F Hernandez; Gregg C Fonarow; Kevin L Thomas; Hussein R Al-Khalidi; Paul A Heidenreich; Stephen Hammill; Clyde Yancy; Eric D Peterson Journal: Circulation Date: 2012-01-27 Impact factor: 29.690
Authors: S Michael Gharacholou; Renato D Lopes; Jeffrey B Washam; L Kristin Newby; Stefan K James; John H Alexander Journal: J Thromb Thrombolysis Date: 2010-05 Impact factor: 2.300
Authors: Khalid A Alnemer; Hussam F Alfaleh; Khalid F Alhabib; Anhar Ullah; Ahmad Hersi; Shukri Alsaif; Amir Taraben; Gamal Hussein; Modather Butt Journal: J Saudi Heart Assoc Date: 2012-08-27
Authors: Felix Post; Evangelos Giannitsis; Thomas Riemer; Lars S Maier; Claus Schmitt; Burghard Schumacher; Gerd Heusch; Harald Mudra; Thomas Voigtländer; Rainer Erbel; Harald Darius; Hugo Katus; Christian Hamm; Jochen Senges; Tommaso Gori; Thomas Münzel Journal: Clin Res Cardiol Date: 2012-07-25 Impact factor: 5.460
Authors: Khalid F Alhabib; Ahmad Hersi; Hussam Alfaleh; Khalid Alnemer; Shukri Alsaif; Amir Taraben; Tarek Kashour; Anas Bakheet; Ayed Al Qarni; Tariq Soomro; Asif Malik; Waqar H Ahmed; Ahmed M Abuosa; Modaser A Butt; Mushabab A Almurayeh; Abdulaziz Al Zaidi; Gamal A Hussein; Mohammed A Balghith; Tareg Abu-Ghazala Journal: J Saudi Heart Assoc Date: 2011-06-01
Authors: Dong Goo Kang; Myung Ho Jeong; Yongkeun Ahn; Shung Chull Chae; Seung Ho Hur; Taek Jong Hong; Young Jo Kim; In Whan Seong; Jei Keon Chae; Jay Young Rhew; In Ho Chae; Myeong Chan Cho; Jang Ho Bae; Seung Woon Rha; Chong Jin Kim; Yang Soo Jang; Junghan Yoon; Ki Bae Seung; Seung Jung Park Journal: J Korean Med Sci Date: 2009-09-23 Impact factor: 2.153