Variations in indicated care of patients with acute coronary syndromes in Queensland hospitals

Objective: To identify variation in the rates of use of key evidence‐based therapies and in clinical outcomes among patients hospitalised with acute coronary syndromes (ACS). Design: Retrospective analysis of data on care processes and clinical outcomes of representative patient samples recorded by...

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Bibliographic Details
Published in:Medical journal of Australia 2005-04, Vol.182 (7), p.325-330
Main Authors: Scott, Ian A, Jones, Mark A, Duke, Andy B, Darwin, Irene C, Harvey, Kathy H
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Adrenergic beta-Antagonists - therapeutic use
Age Factors
Aged
Angina, Unstable - epidemiology
Angina, Unstable - therapy
Anticoagulants - therapeutic use
Australia - epidemiology
Biological and medical sciences
Cardiology. Vascular system
Cardiovascular diseases
Chronic obstructive pulmonary disease
Collaboration
Comorbidity
Coronary Angiography - statistics & numerical data
Coronary heart disease
Counseling - statistics & numerical data
Diabetes Mellitus - epidemiology
Drug Utilization - statistics & numerical data
Female
General aspects
Heart
Heparin - therapeutic use
Hospital Mortality
Hospitals, Public
Humans
Hypolipidemic Agents - therapeutic use
Male
Medical imaging
Medical sciences
Mental disorders
Mental Disorders - epidemiology
Mortality
Myocardial Infarction - epidemiology
Myocardial Infarction - therapy
Patient Readmission
Patient Transfer
Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors
Pulmonary Disease, Chronic Obstructive - epidemiology
Referral and Consultation - statistics & numerical data
Renal Insufficiency - epidemiology
Retrospective Studies
Sex Factors
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Summary:Objective: To identify variation in the rates of use of key evidence‐based therapies and in clinical outcomes among patients hospitalised with acute coronary syndromes (ACS). Design: Retrospective analysis of data on care processes and clinical outcomes of representative patient samples recorded by the Queensland Health Cardiac Collaborative registry. Setting: 18 public hospitals (3 tertiary, 15 non‐tertiary) in Queensland, August 2001  to December 2003. Study population: 2156 patients who died or were discharged after troponin‐positive ACS. Main outcome measures: Comparison of proportions of highly eligible patients receiving indicated care and in‐hospital mortality between subgroups categorised by age, sex, comorbidities (diabetes, renal failure, chronic obstructive pulmonary disease and mental disorder), type of admitting hospital (tertiary or non‐tertiary), and cardiologist involvement (transfer or non‐transfer to cardiology unit). Results: Patients aged ≥ 65 years were less likely than younger patients to receive heparin (79% v 87%), β‐blockers (79% v 87%), lipid‐lowering agents (78% v 87%), coronary angiography (51% v 66%), and referral to cardiac rehabilitation (17% v 33%). Patients with diabetes were less likely than others to receive coronary angiography (50% v 63%), while those with moderate to severe renal failure were less likely to receive thrombolysis (52% v 84%), heparin (71% v 83%), β‐blockers (69% v 84%), lipid‐lowering agents (61% v 84%), in‐hospital cardiac counselling (46% v 64%) and referral to cardiac rehabilitation (9% v 25%). Patients admitted to tertiary hospitals were more likely than those admitted to non‐tertiary hospitals to receive coronary angiography (85% v 55%) and referral to cardiac rehabilitation (36% v 21%). Risk‐adjusted mortality was highest in patients with moderate to severe renal failure (15% v 3%) and older patients (6% v 2%). Conclusions: Variations exist in the provision of indicated care to patients with ACS according to age, diabetic status, renal function and type of admitting hospital. Excess mortality in elderly patients and in those with advanced renal disease may be partially attributable to failure to use key therapies.
ISSN:0025-729X
1326-5377
DOI:10.5694/j.1326-5377.2005.tb06729.x