title: Early treatment for non-ST-segment elevation acute coronary syndrome is associated with appropriate discharge care.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio 45267-0769, USA. gregory.fermann@uc.edu
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Fermann
authors.forename: Ali S
authors.initials: AS
authors.lastname: Raja
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.forename: James W
authors.initials: JW
authors.lastname: Hoekstra
authors.forename: Sarah
authors.initials: S
authors.lastname: Milford-Beland
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Diercks
authors.forename: Charles V
authors.initials: CV
authors.lastname: Pollack
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.forename: Richard
authors.initials: R
authors.lastname: Summers
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.forename: W Brian
authors.initials: WB
authors.lastname: Gibler
mesh_terms: 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
chemical_list: D000319:Adrenergic beta-Antagonists; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin