title: Guideline-adherence and perspectives in the acute management of unstable angina - Initial results from the German chest pain unit registry.
abstract: BACKGROUND
  We investigated the current management of unstable angina pectoris (UAP) in certified chest pain units (CPUs) in Germany and focused on the European Society of Cardiology (ESC) guideline-adherence in the timing of invasive strategies or choice of conservative treatment options. More specifically, we analyzed differences in clinical outcome with respect to guideline-adherence.
  
  
  METHODS
  Prospective data from 1400 UAP patients were collected. Analyses of high-risk criteria with indication for invasive management and 3-month clinical outcome data were performed. Guideline-adherence was tested for a primarily conservative strategy as well as for percutaneous coronary intervention (PCI) within <24 and <72h after admission.
  
  
  RESULTS
  Overall guideline-conforming management was performed in 38.2%. In UAP patients at risk, undertreatment caused by an insufficient consideration of risk criteria was obvious in 78%. Reciprocally, overtreatment in the absence of adequate risk markers was performed in 27%, whereas a guideline-conforming primarily conservative strategy was chosen in 73% of the low-risk patients. Together, the 3-month major adverse coronary and cerebrovascular events (MACCE) were low (3.6%). Nonetheless, guideline-conforming treatment was even associated with significantly lower MACCE rates (1.6% vs. 4.0%, p<0.05).
  
  
  CONCLUSIONS
  The data suggest an inadequate adherence to ESC guidelines in nearly two thirds of the patients, particularly in those patients at high to intermediate risk with secondary risk factors, emphasizing the need for further attention to consistent risk profiling in the CPU and its certification process.
authors.affiliation: Department of Cardiology, Arnsberg Medical Center, Arnsberg, Germany. Electronic address: f.breuckmann@klinikum-arnsberg.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Breuckmann
authors.affiliation: Institute for Myocardial Infarction Research Foundation Ludwigshafen, University of Heidelberg, Heidelberg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hochadel
authors.affiliation: Department of Cardiology, Angiology and Intensive Care Medicine, Vivantes-Klinikum Neukölln, Berlin, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Darius
authors.affiliation: 3rd Department of Medicine, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.affiliation: 2nd Department of Medicine, Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.affiliation: Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Lars S
authors.initials: LS
authors.lastname: Maier
authors.affiliation: Clinic for Cardiology and Angiology, Municipal Hospital Karlsruhe, Karlsruhe, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Schmitt
authors.affiliation: 2nd Department of Medicine, Westpfalz-Klinikum, Kaiserslautern, Germany.
authors.forename: Burghard
authors.initials: B
authors.lastname: Schumacher
authors.affiliation: Institute for Pathophysiology, University Duisburg-Essen, Essen, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Heusch
authors.affiliation: CCB, Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Voigtländer
authors.affiliation: Department of Cardiology, Pneumology and Internal Intensive Care Medicine, Klinikum Neuperlach, Städtisches Klinikum München GmbH, Munich, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Mudra
authors.affiliation: Institute for Myocardial Infarction Research Foundation Ludwigshafen, University of Heidelberg, Heidelberg, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000628:therapy*; D002309:Cardiology; D019468:Disease Management; D005858:Germany; D019983:Guideline Adherence; D006757:Hospital Units; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D013997:Time Factors
keywords: Cardiovascular events; Chest pain unit; Guideline; Timing; Unstable angina