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Impact of acute and chronic risk factors on use of evidence-based treatments in patients in Australia with acute coronary syndromes

journal contribution
posted on 2009-09-01, 00:00 authored by K E Joynt, L Huynh, John Amerena, D B Brieger, S G Coverdale, J M Rankin, A Soman, D P Chew
Objective: To determine whether acute risk factors (ARF) and chronic risk factors (CRF) contribute differently to the use of evidence-based treatments (EBT) for patients with acute coronary syndromes (ACS). Design: Data were collected through a prospective audit of patients with ACS. Management was analysed by the presence of acute myocardial risk factors and chronic comorbid risk factors at presentation. Setting: 39 hospitals across Australia. Patients: 2599 adults presenting with ACS. Interventions: None. Main outcome measures: Use of EBT, in-hospital and 12-month death, recurrent myocardial infarction and bleeding. Results: The number of ARF and CRF at presentation predicted in-hospital and 12-month death, recurrent myocardial infarction and bleeding. Patients with higher numbers of ARF were more likely to receive EBT (aspirin at presentation, 81.1% for zero ARF to 85.7% for ≥3 ARF, p<0.001; angiography 45.9% to 67.5%, p<0.001; reperfusion for ST elevation 50% to 70%, p=0.392; β blocker at discharge 66.5% to 74.4%, p<0.001). Patients with higher numbers of CRF were less likely to receive EBT (aspirin at presentation 90.4% for zero CRF to 68.8% for ≥4 CRF, p<0.001; angiography 78.8% to 24.7%, p<0.001; reperfusion for ST elevation 73.4% to 30%; p<0.001, b blocker at discharge 75.2% to 55.6%; p<0.001). In multivariate regression analysis, ARF and CRF were the strongest predictors of receiving or failing to receive EBT, respectively. Conclusions: Patients presenting with many ARF are more likely to receive EBT, while patients presenting with many CRF are less likely to receive them. This has important implications for future quality-improvement efforts.

History

Journal

Heart

Volume

95

Issue

17

Pagination

1442 - 1448

ISSN

1355-6037

eISSN

1468-201X

Publication classification

C1.1 Refereed article in a scholarly journal

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