title: A cross-sectional multicentre study of cardiac risk score use in the management of unstable angina and non-ST-elevation myocardial infarction.
abstract: OBJECTIVE
  Quantitative risk assessment in unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI), by using cardiac risk scores, is recommended in international guidelines. However, a gap between recommended care and actual practice exists, as these instruments seem underused in practice. The present study aimed to determine the extent of cardiac risk score use and to study factors associated with lower or higher cardiac risk score use.
  
  
  METHODS
  13 hospitals throughout the Netherlands.
  
  
  METHODS
  A retrospective chart review of 1788 charts of patients with UA and NSTEMI, discharged in 2012.
  
  
  METHODS
  The extent of cardiac risk score use reflected in a documented risk score outcome in the patient's chart. Factors associated with cardiac risk score use determined by generalised linear mixed models.
  
  
  RESULTS
  In 57% (n=1019) of the charts, physicians documented the use of a cardiac risk score. Substantial variation between hospitals was observed (16.7-87%), although this variation could not be explained by the presence of on-site revascularisation facilities or a hospitals' teaching status. Obese patients (OR=1.49; CI 95%1.03 to 2.15) and former smokers (OR=1.56; CI 95%1.15 to 2.11) were more likely to have a cardiac risk score documented. Risk scores were less likely to be used among patients diagnosed with UA (OR=0.60; CI 95% 0.46 to 0.77), in-hospital resuscitation (OR=0.23; CI 95% 0.09 to 0.64), in-hospital heart failure (OR=0.46; CI 95% 0.27 to 0.76) or tachycardia (OR=0.45; CI 95% 0.26 to 0.75).
  
  
  CONCLUSIONS
  Despite recommendations in cardiac guidelines, the use of cardiac risk scores has not been fully implemented in Dutch practice. A substantial number of patients did not have a cardiac risk score documented in their chart. Strategies to improve cardiac risk score use should pay special attention to patient groups in which risk scores were less often documented, as these patients may currently be undertreated.
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Josien
authors.initials: J
authors.lastname: Engel
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Ineke
authors.initials: I
authors.lastname: van der Wulp
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Martine
authors.initials: M
authors.lastname: de Bruijne
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006333:Heart Failure / Q000175:diagnosis*; D006801:Humans; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis*; D009426:Netherlands; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*
keywords: acute coronary syndromes; chart review; guideline adherence; predictors; risk assessment