Objective: To determine whether acute risk factors (ARF) and chronic risk factors (CRF) contribute differently to the use of evidence-based therapies (EBT) for patients with acute coronary syndromes (ACS).
Design: Data was collected via a prospective audit of patients with ACS. Management was analyzed 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.
Main outcome measures: Utilization of evidence-based therapies, 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 outcomes. 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 or more ARF, p<0.001, angiography 45.9% to 67.5%, p<0.001, reperfusion for ST-elevation 50% to 70%, p=0.392), beta-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 or more CRF, p<0.001, angiography 78.8% to 24.7%, p<0.001, reperfusion for ST elevation 73.4% to 30%, p<0.001, beta-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 acute risk factors are more likely to receive EBT, while patients presenting with many chronic risk factors are less likely to receive them. This has important implications for future quality-improvement efforts.
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