Skip to main content
release_alert
Welcome to the new Scholars 3.0! Read about new features and let us know what you think.
cancel
Journal cover image

The influence of risk status on guideline adherence for patients with non-ST-segment elevation acute coronary syndromes.

Publication ,  Journal Article
Roe, MT; Peterson, ED; Newby, LK; Chen, AY; Pollack, CV; Brindis, RG; Harrington, RA; Christenson, RH; Smith, SC; Califf, RM; Braunwald, E ...
Published in: Am Heart J
June 2006

BACKGROUND: Practice guidelines for patients with non-ST-segment elevation (NSTE) acute coronary syndromes (ACS) recommend targeting evidence-based therapies for the highest-risk patients. We characterized guideline adherence for NSTE ACS by risk status. METHODS: We analyzed inhospital treatments and outcomes for 77760 patients with NSTE ACS (ischemic ST-segment changes and/or positive cardiac markers) included in the CRUSADE initiative from January 2001 to September 2003 at 457 US hospitals. Compliance with the American College of Cardiology/American Heart Association Class guideline recommendations for NSTE ACS was evaluated in subgroups of eligible patients without listed contraindications at increased risk for mortality and among risk categories designated by an adapted version of the PURSUIT risk model designed to predict inhospital mortality. RESULTS: Inhospital mortality was increased in patients with diabetes mellitus (5.8% vs 4.3%), renal insufficiency (10.0% vs 3.9%), signs of congestive heart failure on presentation (10.6% vs 3.1%), and age > or = 75 years (8.6% vs 2.7%), compared with patients without these features. Use of guideline-recommended acute medications, invasive cardiac procedures, and discharge medications and interventions was significantly lower in patients with these high-risk features. Patients designated as high-risk for inhospital mortality were less likely to be treated with guideline-recommended therapies compared with low-risk and moderate-risk patients. CONCLUSIONS: Patients with NSTE ACS with the highest risk of mortality are less likely to receive guideline-recommended therapies and interventions. These findings highlight the need to clarify guideline recommendations for high-risk patients and to develop novel quality improvement approaches that target undertreated subgroups of patients with NSTE ACS.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

June 2006

Volume

151

Issue

6

Start / End Page

1205 / 1213

Location

United States

Related Subject Headings

  • Risk Factors
  • Myocardial Infarction
  • Humans
  • Guideline Adherence
  • Cardiovascular System & Hematology
  • Angina, Unstable
  • Aged
  • Acute Disease
  • 1117 Public Health and Health Services
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Roe, M. T., Peterson, E. D., Newby, L. K., Chen, A. Y., Pollack, C. V., Brindis, R. G., … Ohman, E. M. (2006). The influence of risk status on guideline adherence for patients with non-ST-segment elevation acute coronary syndromes. Am Heart J, 151(6), 1205–1213. https://doi.org/10.1016/j.ahj.2005.08.006
Roe, Matthew T., Eric D. Peterson, L Kristin Newby, Anita Y. Chen, Charles V. Pollack, Ralph G. Brindis, Robert A. Harrington, et al. “The influence of risk status on guideline adherence for patients with non-ST-segment elevation acute coronary syndromes.Am Heart J 151, no. 6 (June 2006): 1205–13. https://doi.org/10.1016/j.ahj.2005.08.006.
Roe MT, Peterson ED, Newby LK, Chen AY, Pollack CV, Brindis RG, et al. The influence of risk status on guideline adherence for patients with non-ST-segment elevation acute coronary syndromes. Am Heart J. 2006 Jun;151(6):1205–13.
Roe, Matthew T., et al. “The influence of risk status on guideline adherence for patients with non-ST-segment elevation acute coronary syndromes.Am Heart J, vol. 151, no. 6, June 2006, pp. 1205–13. Pubmed, doi:10.1016/j.ahj.2005.08.006.
Roe MT, Peterson ED, Newby LK, Chen AY, Pollack CV, Brindis RG, Harrington RA, Christenson RH, Smith SC, Califf RM, Braunwald E, Gibler WB, Ohman EM. The influence of risk status on guideline adherence for patients with non-ST-segment elevation acute coronary syndromes. Am Heart J. 2006 Jun;151(6):1205–1213.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

June 2006

Volume

151

Issue

6

Start / End Page

1205 / 1213

Location

United States

Related Subject Headings

  • Risk Factors
  • Myocardial Infarction
  • Humans
  • Guideline Adherence
  • Cardiovascular System & Hematology
  • Angina, Unstable
  • Aged
  • Acute Disease
  • 1117 Public Health and Health Services
  • 1102 Cardiorespiratory Medicine and Haematology