Quality of care for acute coronary syndrome patients with known atherosclerotic disease: results from the Get With the Guidelines Program.
BACKGROUND
Patients with prior atherosclerosis in 1 or more vascular territories (coronary, cerebrovascular, or peripheral arterial) who present with acute coronary syndromes have high cardiovascular risk and may benefit significantly from evidence-based therapies, yet whether these are used consistently is unknown.


RESULTS
The Get With the Guidelines-Coronary Artery Disease database was queried to determine whether compliance with quality-of-care treatments for acute coronary syndrome patients was associated with the extent of prior vascular disease. A total of 143 999 patients enrolled at 438 sites between January 2000 and January 2008 were classified according to the absence (n=98 136; 68%) or presence of known preexistent atherosclerosis (before admission) in 1, 2, or 3 vascular territories (n=37 633 [26%], n=7369 [5%], and n=861 [0.6%], respectively). Overall in-hospital mortality was 5.3%, and mean length of stay was 5.6+/-6.7 days. Compared with patients without prior vascular disease, patients with prior vascular disease were older and had more comorbidities. They were less likely to undergo coronary revascularization and had longer duration of hospital stay and higher in-hospital mortality. After adjustment for clinical and hospital characteristics, compared with patients without prior vascular disease, patients with prior vascular disease had higher mortality and were less likely to receive 3 particular treatments (lipid-lowering therapy, smoking cessation counseling, and angiotensin-converting enzyme inhibitor for left ventricular dysfunction).


CONCLUSIONS
Compared with acute coronary syndrome patients without prior vascular disease, those with prior atherosclerosis had higher in-hospital mortality yet were paradoxically less likely to receive specific evidence-based acute coronary syndrome treatments, which can form the basis for targeted intervention.
Brilakis
Emmanouil S
ES
VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, USA. esbrilakis@yahoo.com
Hernandez
Adrian F
AF
Dai
David
D
Peterson
Eric D
ED
Banerjee
Subhash
S
Fonarow
Gregg C
GC
Cannon
Christopher P
CP
Bhatt
Deepak L
DL
D054058:Acute Coronary Syndrome / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000572:American Heart Association; D015906:Angioplasty, Balloon, Coronary; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D016540:Smoking Cessation; D014481:United States
D000806:Angiotensin-Converting Enzyme Inhibitors; D000960:Hypolipidemic Agents