RT Journal Article
SR Electronic
T1 Impact of acute and chronic risk factors on use of evidence-based treatments in patients in Australia with acute coronary syndromes
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1442
OP 1448
DO 10.1136/hrt.2008.154781
VO 95
IS 17
A1 K E Joynt
A1 L Huynh
A1 J V Amerena
A1 D B Brieger
A1 S G Coverdale
A1 J M Rankin
A1 A Soman
A1 D P Chew
YR 2009
UL http://heart.bmj.com/content/95/17/1442.abstract
AB 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.