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.
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.
Authors: Deborah B Diercks; Michael C Kontos; Judd E Hollander; Bryn E Mumma; DaJuanicia N Holmes; Stephen Wiviott; Jorge F Saucedo; James A de Lemos Journal: Am J Emerg Med Date: 2013-05-20 Impact factor: 2.469
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: Stefan K James; Matthew T Roe; Christopher P Cannon; Jan H Cornel; Jay Horrow; Steen Husted; Hugo Katus; Joao Morais; Ph Gabriel Steg; Robert F Storey; Susanna Stevens; Lars Wallentin; Robert A Harrington Journal: BMJ Date: 2011-06-17
Authors: Leonardo De Luca; Furio Colivicchi; Michele Massimo Gulizia; Francesco Rocco Pugliese; Maria Pia Ruggieri; Giuseppe Musumeci; Gian Alfonso Cibinel; Francesco Romeo Journal: Eur Heart J Suppl Date: 2017-05-02 Impact factor: 1.803
Authors: Daniel Lindholm; Christoph Varenhorst; Christopher P Cannon; Robert A Harrington; Anders Himmelmann; Juan Maya; Steen Husted; Philippe Gabriel Steg; Jan H Cornel; Robert F Storey; Susanna R Stevens; Lars Wallentin; Stefan K James Journal: Eur Heart J Date: 2014-04-11 Impact factor: 29.983