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Secondary prevention of coronary disease
Impact of acute and chronic risk factors on use of evidence-based treatments in patients in Australia with acute coronary syndromes
  1. K E Joynt1,
  2. L Huynh2,
  3. J V Amerena3,
  4. D B Brieger4,
  5. S G Coverdale5,
  6. J M Rankin6,
  7. A Soman7,
  8. D P Chew2
  1. 1
    Duke University Medical Center/Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02215 USA
  2. 2
    Flinders University/Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia 5042, Australia
  3. 3
    Geelong Hospital, 60-62 Bellerine St, Geelong, VIC 3220, Australia
  4. 4
    Concord Hospital, Hospital Road, Concord, NSW 2139, Australia
  5. 5
    Nambour Hospital, Hospital Road, Nambour, Qld 4560, Australia
  6. 6
    Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia
  7. 7
    Sanofi-Aventis Australia, Talavera Corporate Centre, Building D, 12-24 Talavera Road, Macquarie Park, NSW 2113, Australia
  1. Correspondence to Professor D P Chew, Cardiovascular Outcomes Research, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia 5042, Australia; Derek.chew{at}flinders.edu.au

Abstract

Objective: To determine whether acute risk factors (ARF) and chronic risk factors (CRF) contribute differently to the use of evidence-based treatments (EBT) for patients with acute coronary syndromes (ACS).

Design: Data were collected through a prospective audit of patients with ACS. Management was analysed by the presence of acute myocardial risk factors and chronic comorbid risk factors at presentation.

Setting: 39 hospitals across Australia.

Patients: 2599 adults presenting with ACS.

Interventions: None.

Main outcome measures: Use of EBT, in-hospital and 12-month death, recurrent myocardial infarction and bleeding.

Results: The number of ARF and CRF at presentation predicted in-hospital and 12-month death, recurrent myocardial infarction and bleeding. Patients with higher numbers of ARF were more likely to receive EBT (aspirin at presentation, 81.1% for zero ARF to 85.7% for ⩾3 ARF, p<0.001; angiography 45.9% to 67.5%, p<0.001; reperfusion for ST elevation 50% to 70%, p = 0.392; β blocker at discharge 66.5% to 74.4%, p<0.001). Patients with higher numbers of CRF were less likely to receive EBT (aspirin at presentation 90.4% for zero CRF to 68.8% for ⩾4 CRF, p<0.001; angiography 78.8% to 24.7%, p<0.001; reperfusion for ST elevation 73.4% to 30%; p<0.001, β blocker at discharge 75.2% to 55.6%; p<0.001). In multivariate regression analysis, ARF and CRF were the strongest predictors of receiving or failing to receive EBT, respectively.

Conclusions: Patients presenting with many ARF are more likely to receive EBT, while patients presenting with many CRF are less likely to receive them. This has important implications for future quality-improvement efforts.

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Footnotes

  • Funding This work was in part supported by a grant from the Hubert-Yeargan Center for Global Health at Duke University Medical Center, Boston, USA.

  • Competing interests AS is an employee of Sanofi-Aventis, Australia.

  • Ethics approval Approval from the ethics committees of all participating hospitals (see appendix).

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