Comparative trends in guidelines adherence among patients with non-ST-segment elevation acute coronary syndromes treated with invasive versus conservative management strategies: Results from the CRUSADE quality improvement initiative.
BACKGROUND
Prior studies have demonstrated differences in adherence to non-ST-segment elevation acute coronary syndromes (NSTE ACS) guidelines-recommended therapies among patients managed conservatively without cardiac catheterization compared with those managed invasively. We evaluated the degree of yearly change in use of guidelines-recommended therapies for patients with NSTE ACS in CRUSADE stratified by use of cardiac catheterization and revascularization procedures.


METHODS
We analyzed data from 138,714 high-risk patients with NSTE ACS treated at 547 hospitals during the first 4 years of the CRUSADE initiative. Patients were categorized as no cardiac catheterization (29% of the total population), cardiac catheterization without revascularization (21%), percutaneous coronary intervention (40%), and coronary artery bypass graft surgery (11%). Composite guidelines adherence scores were used to compare yearly changes in use of guidelines-recommended therapies among the groups.


RESULTS
Although guidelines adherence improved in all 4 groups each year and was consistently highest in the percutaneous coronary intervention group, the adjusted yearly increase in the use of acute guidelines-recommended medications was highest in the no cardiac catheterization group, and the adjusted yearly increase in the use of discharge medications was highest in the coronary artery bypass graft surgery group.


CONCLUSIONS
Improvements in the use of guidelines-recommended therapies were seen among all patients with NSTE ACS in CRUSADE over a 4-year period regardless of management strategy, and the trajectory of improvement in acute care was greatest in patients managed conservatively.
University of California-Davis, USA.
Ezra A
EA
Amsterdam
Eric D
ED
Peterson
Fang-Shu
FS
Ou
L Kristin
LK
Newby
Charles V
CV
Pollack
W Brian
WB
Gibler
E Magnus
EM
Ohman
Matthew T
MT
Roe
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000628:therapy*; D006328:Cardiac Catheterization; D019992:Databases as Topic; D004562:Electrocardiography; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic