title: Regional outcomes after admission for high-risk non-ST-segment elevation acute coronary syndromes.
abstract: OBJECTIVE
  An analysis of reginal variation across the United States in the treatment and outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) has not been previously performed.
  
  
  METHODS
  We assessed contemporary practice and outcomes in 56,466 high-risk patients with NSTE ACS (positive cardiac markers and/or ischemic ST-segment changes) admitted to 310 hospitals across four defined regions in the United States from January 1, 2001, to September 30, 2003. Patient clinical characteristics, acute (<24 hours) and discharge medications, in-hospital procedures, and in-hospital case-fatality rates were evaluated.
  
  
  RESULTS
  Statistically significant but clinically small differences in baseline characteristics including age, gender, rates of diabetes, hypertension, and smoking, as well as medical treatment, including a greater than 5% variation in acute use of beta-blockers, clopidogrel, and statins use, were noted across regions. Adjusted rates of revascularization were similar across regions. Overall in-hospital case-fatality rate was 4.1%, with the highest rates in the Midwest (4.6%) and the lowest in the Northeast (3.5%). Adjusted odds ratios (OR) (95% confidence interval [CI] for death were significantly higher in the Midwest (OR 1.42, CI 1.19-1.70), West (OR 1.40 CI 1.05-1.87), and South (OR 1.33, CI 1.08-1.62), compared with the Northeast.
  
  
  CONCLUSIONS
  Management of high-risk patients with NSTE ACS is relatively uniform across the United States. However, in-hospital case-fatality rates vary significantly by region, and the differences are not explained by adjustment for standard clinical variables.
authors.affiliation: Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. menonv@ccf.org
authors.forename: Venu
authors.initials: V
authors.lastname: Menon
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Ralph G
authors.initials: RG
authors.lastname: Brindis
authors.forename: Anita Y
authors.initials: AY
authors.lastname: Chen
authors.forename: Charles V
authors.initials: CV
authors.lastname: Pollack
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
authors.forename: W Brian
authors.initials: WB
authors.lastname: Gibler
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D006306:Health Surveys; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States