Use of evidence-based management for acute coronary syndrome.
OBJECTIVE
This study compared the management of acute coronary syndrome (ACS) for patients admitted to Dunedin Coronary Care with evidence-based recommendations from the American College of Cardiology / American Heart Association in 1999 and 2002 and with management reported in international and local registries.


METHODS
All patients with ACS from 2001-2002 were included.


RESULTS
Guidelines stated that aspirin, beta-blockers, statins, and ACE-inhibitors/angiotensin-II-blockers are appropriate treatment for acute coronary syndrome. These medications were prescribed respectively in 98%, 80%, 70% and 55% of patients on discharge. In patients with documented dyslipidaemia, Statins was prescribed in 80% on discharge. The use of ACE inhibitors was 73% in patients with impaired left ventricular function, 79% in patients with clinical heart failure and 84% in patients with anterior ST-elevation myocardial infarction (STEMI). For patients with STEMI, 67% received coronary angiography, 50% had PCI and 7% underwent inpatient coronary artery bypass grafting. For Non-ST-elevation myocardial infarction (NSTEMI), the respective numbers were 73%, 38% and 21%. Our use of evidence-based medications was consistent with published guidelines and comparable to results of international registries (CRUSADE, EUROESPIRE II, GRACE) in 2001-2002.


CONCLUSIONS
There is good adherence to the use of evidence-based management for acute coronary syndrome in Dunedin Coronary Care Unit.
Tang
Eng
E
Department of Cardiology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Wong
Cheuk-Kit
CK
Wilkins
Gerard
G
Herbison
Peter
P
Williams
Michael
M
Kay
Patrick
P
Restieaux
Norma
N
D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002309:Cardiology / Q000592:standards*; D000077144:Clopidogrel; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000175:diagnosis / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D009520:New Zealand; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000925:Anticoagulants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin