Current management of acute coronary syndromes in Australia: observations from the acute coronary syndromes prospective audit.
BACKGROUND
Acute coronary syndromes (ACS) management is now well informed by guidelines extrapolated from clinical trials. However, most of these data have been acquired outside the local context. We sought to describe the current patterns of ACS care in Australia.


METHODS
The Acute Coronary Syndrome Prospective Audit study is a prospective multi-centre registry of ST-segment elevation myocardial infarction (STEMI), high-risk non-ST-segment elevation ACS (NSTEACS-HR) and intermediate-risk non-ST-segment elevation ACS (NSTEACS-IR) patients, involving 39 metropolitan, regional and rural sites. Data included hospital characteristics, geographic and demographic factors, risk stratification, in-hospital management including invasive services, and clinical outcomes.


RESULTS
A cohort of 3402 patients was enrolled; the median age was 65.5 years. Female and non-metropolitan patients comprised 35.5% and 23.9% of the population, respectively. At enrolment, 756 (22.2%) were STEMI patients, 1948 (57.3%) were high-risk NSTEACS patients and 698 (20.5%) were intermediate-risk NSTEACS patients. Evidence-based therapies and invasive management use were highest among suspected STEMI patients compared with other strata (angiography: STEMI 89%, NSTEACS-HR 54%, NSTEACS-IR 34%, P < 0.001) (percutaneous coronary intervention: STEMI 68.1%, NSTEACS-HR 22.2%, NSTEACS-IR 8.1%, P < 0.001). In hospital mortality was low (STEMI 4.0%, NSTEACS-HR 1.8%, NSTEACS-IR 0.1%, P < 0.001), as was recurrent MI (STEMI 2.4%, NSTEACS-HR: 2.8%, NSTEACS-IR 1.2%, P = 0.052).


CONCLUSIONS
There appears to be an 'evidence-practice gap' in the management of ACS, but this is not matched by an increased risk of in-hospital clinical events. Objective evaluation of local clinical care is a key initial step in developing quality improvement initiatives and this study provides a basis for the improvement in ACS management in Australia.
Chew
D P
DP
Department of Cardiology, Flinders University, Flinders Medical Centre, Adelaide, South Australia. derek.chew@flinders.edu.au
Amerena
J
J
Coverdale
S
S
Rankin
J
J
Astley
C
C
Brieger
D
D
D000368:Aged; D000789:Angina, Unstable / Q000628:therapy*; D001315:Australia; D015331:Cohort Studies; D003695:Delivery of Health Care; D004562:Electrocardiography; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006329:Heart Conduction System; D006801:Humans; D008297:Male; D008485:Medical Audit; D009203:Myocardial Infarction / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012424:Rural Population; D012720:Severity of Illness Index; D014505:Urban Population