[In-hospital management of acute coronary syndrome patients: influence of age, gender and admission department on medical policy and outcome].
BACKGROUND
Although the improvement of therapeutic strategies is leading to a dramatic decline of in-hospital acute coronary syndrome (ACS) death rates, differences in care and prognosis of ACS patients exist when age, gender and admission department are considered.


METHODS
The national hospital informative system was used. Only data recorded in three Italian Regions from December 1, 2005 to November 30, 2007 were analyzed. This approach allowed to identify 70 413 patients reporting ACS as primary or secondary diagnosis. The ACS cohort was stratified by age (≤64, 65-74 and ≥75 years) and gender. ACS events were divided into two groups: 42 503 patients with non-ST-elevation ACS (NSTE-ACS) and 27 910 patients with ST-elevation ACS (STEMI). The proportion of NSTE-ACS and STEMI patients treated in general medicine or cardiology departments requiring a coronary procedure or extensive investigations, and in-hospital 30-day mortality rates adjusted by age and gender were analyzed.


RESULTS
19% of STEMI and 15% of NSTE-ACS patients are admitted to a general medicine department. For STEMI patients, the proportion increases up to 37.6% when females aged ≥75 years are considered. Patients undergo a coronary procedure or extensive investigations less commonly in general medicine than in cardiology departments; in-hospital 30-day adjusted mortality rates in general medicine departments are approximately 2-fold higher than those recorded in cardiology departments (STEMI: 26.4 vs 16.7%; NSTE-ACS: 7.7 vs 4.2%).


CONCLUSIONS
In-hospital mortality rates of ACS patients admitted to cardiology departments are lower than those reported in general medicine departments. Nevertheless, in-hospital management of women and elderly ACS patients does not completely comply with the recommended guidelines and exposes them to unfavorable prognosis.
Centro Nazionale di Epidemiologia, Istituto Superiore di Sanita, Roma. fulvia.seccareccia@iss.it
Fulvia
F
Seccareccia
Stefano
S
Rosato
Paola
P
D'Errigo
Alice
A
Maraschini
Rosa Maria
RM
Manfredi
Mariaelena
M
Lombardi
Gabriella
G
Badoni
Cesare
C
Greco
D054058:Acute Coronary Syndrome / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D005260:Female; D006748:Hospital Departments; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012737:Sex Factors; D016896:Treatment Outcome