title: Translation of acute coronary syndrome therapies: from evidence to routine clinical practice.
abstract: BACKGROUND
  The use of evidence-based therapies has improved the outcome of patients with acute coronary syndrome (ACS), but there is a time lag between the generation of clinical evidence and its application in routine clinical practice. We sought to quantify temporal lags in the lifecycle of American College of Cardiology (ACC)/American Heart Association (AHA) class IA ACS therapies.
  
  
  METHODS
  Using current and historical ACC/AHA guideline publications, we retrieved publication dates of pivotal clinical trials (PCTs) and class IA guideline-recommended therapies for patients with ST-elevation myocardial infarction (STEMI) and unstable angina (UA)/non-STEMI (NSTEMI). Clinical practice uptake data for each therapy were retrieved from the National Registry for Myocardial Infarction, Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines, and Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines, which are registries containing publicly available peer-reviewed data. Descriptive data were calculated and compared for each phase of the evidence lifecycle for both STEMI and UA/NSTEMI drug classifications.
  
  
  RESULTS
  We identified 11 class IA- and 4 class IB/IC-recommended therapies for acute, inhospital, and discharge use for patients with STEMI or UA/NSTEMI. The median time lags were 2 years (interquartile range [IQR], 1-4 years) from PCT to practice guideline recommendation, 14 years (IQR, 11-15 years) from guideline recommendation to 90% practice uptake, and overall, a 16-year median (IQR, 13-19 years) from PCT to 90% practice uptake.
  
  
  CONCLUSIONS
  The time of PCT publication to meaningful uptake of class IA ACS therapies into clinical practice took a median of 16 years. This significant time lag indicates systemic barriers to the translation of therapeutics into routine clinical practice.
authors: Duke-National University of Singapore Graduate Medical School, Singapore.
authors: Martin
authors: M
authors: Putera
authors: Duke University School of Medicine, Durham, NC.
authors: Robin
authors: R
authors: Roark
authors: Duke Clinical Research Institute, Durham, NC.
authors: Renato D
authors: RD
authors: Lopes
authors: Duke-National University of Singapore Graduate Medical School, Singapore; Duke University School of Medicine, Durham, NC.
authors: Krishna
authors: K
authors: Udayakumar
authors: Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC.
authors: Eric D
authors: ED
authors: Peterson
authors: Duke University School of Medicine, Durham, NC; Duke Translational Medicine Institute, Durham, NC.
authors: Robert M
authors: RM
authors: Califf
authors: Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC. Electronic address: bimal.shah@duke.edu.
authors: Bimal R
authors: BR
authors: Shah
mesh_terms: D000789:Angina, Unstable / Q000628:therapy*; D002317:Cardiovascular Agents / Q000145:classification / Q000627:therapeutic use; D003144:Communication Barriers; D061345:Early Medical Intervention / Q000379:methods / Q000592:standards; D055317:Evidence-Based Practice; D019983:Guideline Adherence; D006801:Humans; D062527:Meaningful Use; D009203:Myocardial Infarction / Q000628:therapy*; D020380:Needs Assessment; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012042:Registries / Q000706:statistics & numerical data; D018570:Risk Assessment; D057170:Translational Research, Biomedical / Q000379:methods / Q000592:standards
chemical_list: D002317:Cardiovascular Agents