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ISCHAEMIC HEART DISEASE
Data from the > 20 000 patients in the GRACE registry of acute coronary syndromes (ACS) suggests several important take-home messages. This study focused on quality of care. Use of medications in eligible patients at discharge ranged from 73% for angiotensin converting enzyme (ACE) inhibitors to 93% for aspirin. High risk features (for example, heart failure, older age) were related to failure to use aspirin and ß blockers. Being treated at a teaching hospital and care by a cardiologist were associated with greater use of aspirin and ß blockers. Coronary artery bypass surgery (CABG) was associated with failure to use ACE inhibitors and aspirin. When hospitals were divided into quartiles of quality performance, adjusted in-hospital mortality was 4.1% in the top versus 5.6% in the bottom quartile, representing a 27% (95% confidence interval (CI) 11% to 42%) lower relative mortality. So, special care to ensure appropriate use of medical treatments
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