title: Hospital revascularisation capability and quality of care after an acute coronary syndrome in Switzerland.
abstract: BACKGROUND
  Patients with acute coronary syndrome (ACS) transferred to regional nonacademic hospitals after percutaneous coronary intervention (PCI) may receive fewer preventive interventions than patients who remain in university hospitals. We aimed at comparing hospitals with and without PCI facilities regarding guidelines-recommended secondary prevention interventions after an ACS.
  
  
  METHODS
  We studied patients with ACS admitted to a university hospital with PCI facilities in Switzerland, and either transferred within 48 hours to regional nonacademic hospitals without PCI facilities or directly discharged from the university hospital. We measured prescription rates of evidence-based recommended therapies after ACS including reasons for nonprescription of aspirin, statins, β-blockers, angiotensin converting-enzyme inhibitors (ACEI) / angiotensin II receptor blockers (ARB), along with cardiac rehabilitation attendance and delivery of a smoking cessation intervention.
  
  
  RESULTS
  Overall, 720 patients with ACS were enrolled; 541 (75.1%) were discharged from the hospital with PCI facilities, 179 (24.9%) were transferred to hospitals without PCI facilities. Concomitant prescription of aspirin, β-blockers, ACEI/ARB and statins at discharge was similar in hospitals with and without PCI facilities, reaching 83.9% and 85.5%, respectively (p = 0.62). Attendance at cardiac rehabilitation reached 55.5% for the hospital with PCI facilities and 65.7% for hospitals without PCI facilities (p = 0.02). In-hospital smoking cessation interventions were delivered to 70.8% patients exclusively at the hospital with PCI facilities.
  
  
  CONCLUSIONS
  Quality of care for patients with ACS discharged from hospitals without PCI facilities was similar to that of patients directly discharged from the hospital with PCI facilities, except for in-hospital smoking cessation counselling and cardiac rehabilitation attendance.
authors: Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
authors: Joris
authors: J
authors: Welker
authors: Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
authors: Reto
authors: R
authors: Auer
authors: Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
authors: Baris
authors: B
authors: Gencer
authors: Service of Cardiology, CHUV, Lausanne, Switzerland.
authors: Olivier
authors: O
authors: Muller
authors: Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
authors: Jacques
authors: J
authors: Cornuz
authors: Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors: Christian M
authors: CM
authors: Matter
authors: Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
authors: François
authors: F
authors: Mach
authors: Department of Cardiology, University Hospital Bern, Bern, Switzerland.
authors: Stephan
authors: S
authors: Windecker
authors: Department of General Internal Medicine, University Hospital of Bern, Bern, Switzerland.
authors: Nicolas
authors: N
authors: Rodondi
authors: Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
authors: David
authors: D
authors: Nanchen
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D062645:Percutaneous Coronary Intervention / Q000534:rehabilitation*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D055502:Secondary Prevention / Q000592:standards*; D016540:Smoking Cessation / Q000706:statistics & numerical data; D013557:Switzerland
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin