Early treatment for non-ST-segment elevation acute coronary syndrome is associated with appropriate discharge care.
BACKGROUND
Acute treatment is associated with improved in-hospital outcomes for patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS).


OBJECTIVE
Patients who receive appropriate acute treatment are more likely to receive guideline-recommended therapy at hospital discharge.


METHODS
Use of aspirin (ASA), beta-blockers, and clopidogrel was evaluated in the first 24 hours and upon hospital discharge according to the 2002 American College of Cardiology/American Heart Association (ACC AHA) guidelines for NSTE ACS. We compared the relationship between 3 groups: (1) ASA therapy given in the emergency department (ED); (2) ASA therapy not given in the ED, but within the first 24 hours; and (3) no acute ASA treatment. The ASA data set includes 10,468 high risk patients with positive cardiac biomarkers or ischemic ST-segment changes on ECG from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) Quality Improvement Initiative. Beta-blocker therapy was evaluated in 11,838 and clopidogrel treatment in 17,513 patients presenting to over 345 US hospitals.


RESULTS
Patients who received acute ASA in the ED, ASA in the first 24 hours but not in the ED, and patients who did not receive ASA therapy within 24 hours had discharge ASA treatment rates of 91.8%, 91.4%, and 55.6%, respectively (P < 0.0001). Patients eligible for beta-blocker and clopidogrel therapy had discharge beta-blocker treatment rates of 91.1%, 92.4%, and 46.6% (P < 0.0001), and discharge clopidogrel treatment rates of 86.6%, 92.4%, and 38.5% (P < 0.0001), respectively.


CONCLUSIONS
Acute treatment for NSTE ACS in-hospital is associated with appropriate treatment on hospital discharge. This link between early treatment and discharge therapy may lead to new approaches ensuring the delivery of high-quality, guideline-based care for patients with NSTE ACS.
Fermann
Gregory J
GJ
Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio 45267-0769, USA. gregory.fermann@uc.edu
Raja
Ali S
AS
Peterson
Eric D
ED
Roe
Matthew T
MT
Hoekstra
James W
JW
Milford-Beland
Sarah
S
Diercks
Deborah B
DB
Pollack
Charles V
CV
Peacock
W Frank
WF
Summers
Richard
R
Ohman
E Magnus
EM
Gibler
W Brian
WB
D054058:Acute Coronary Syndrome / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage*; D000077144:Clopidogrel; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin