title: Variations in the application of cardiac care in Australia.
abstract: OBJECTIVE
  To evaluate the use of clinical practice guidelines for the management of acute coronary syndromes published by the National Heart Foundation (NHF) of Australia and the Cardiac Society of Australia and New Zealand (CSANZ) in patients presenting with chest pain.
  
  
  METHODS
  Cross-sectional study of consecutive patients admitted with chest pain.
  
  
  METHODS
  Prospective case note review was undertaken in 2380 patients admitted to 27 hospitals across five states in Australia between January 2003 and August 2005. Patients were divided into two groups: those who presented to centres with angiography and percutaneous intervention facilities (n = 1260) and those treated at centres without these facilities (n = 1120).
  
  
  METHODS
  The proportion of patients whose care met quality of care standards for diagnostic and risk-stratification procedures and management according to NHF/CSANZ treatment guidelines.
  
  
  RESULTS
  Significant delays were identified in performing electrocardiography, administering thrombolysis, transferring high-risk patients to tertiary centres, and performing revascularisation. Medical therapy was underused, especially glycoprotein IIb/IIIa antagonists in patients with high-risk acute coronary syndromes. Patients treated at centres without interventional facilities were less likely to receive guidelines-based medical therapy and referral for coronary angiography (20.11%) than patients treated at centres with interventional facilities (66.43%; P < 0.001).
  
  
  CONCLUSIONS
  There are deficits in the implementation and adherence to evidence-based guidelines for managing chest pain in hospitals across Australia, and significant differences between hospitals with and without interventional facilities.
authors.affiliation: Department of Cardiology, Prince Charles Hospital, Brisbane, QLD, Australia. Darren_Walters@health.qld.gov.au
authors.forename: Darren L
authors.initials: DL
authors.lastname: Walters
authors.forename: Constantine N
authors.initials: CN
authors.lastname: Aroney
authors.forename: Derek P
authors.initials: DP
authors.lastname: Chew
authors.forename: Linden
authors.initials: L
authors.lastname: Bungey
authors.forename: Steven G
authors.initials: SG
authors.lastname: Coverdale
authors.forename: Roger
authors.initials: R
authors.lastname: Allan
authors.forename: David
authors.initials: D
authors.lastname: Brieger
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002300:Cardiac Care Facilities / Q000592:standards* / Q000706:statistics & numerical data; D002637:Chest Pain / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care; D012017:Referral and Consultation; D013997:Time Factors; D014218:Triage