Segment Elevation Acute Coronary Syndromes: Results From the advertise National Quality Improvement InitiativeJournal of the American College of Cardiology, Volume 46. Issue 8, 18 October 2005. Pages 1479-1487Karen P. Alexander. Matthew T. Roe. Anita Y. Chen. Barbara L. Lytle. Charles V. Pollack. Jr. Joanne M. Foody. William E. Boden. Sidney C. Smith. Jr. W. Brian Gibler. E. Magnus Ohman and Eric D. PetersonAbstract
In 56,963 patients with NSTE ACS at 443 U. S hospitals participating in the Can Rapid assay Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) National Quality Improvement Initiative from January 2001 to June 2003 we compared use of guidelines-recommended care across four age groups: <65. 65 to 74. 75 to 84 and ≥85 years. A multivariate copy tested for age-related differences in treatments and outcomes after adjusting for patient provider and hospital factors.
Of the study population. 35% were ≥75 years old and 11% were ≥85 years old. Use of acute anti-platelet and anti-thrombin therapy within the first 24 h decreased with age. Elderly patients were also less likely to undergo early catheterization or revascularization. Whereas use of many discharge medications was similar in young and old patients clopidogrel and lipid-lowering therapy remained less commonly prescribed in elderly patients. In-hospital mortality and complication rates increased with advancing age but those receiving more recommended therapies had lower mortality even after adjustment than those who did not.
The Can Rapid assay Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines (advertise) initiative is a prospective rapid-cycle quality-improvement initiative that focuses on improving both the diagnostic evaluation of patients with non–ST-segment elevation (NSTE) acute coronary syndromes (ACS; defined as ischemic ST-segment changes and/or positive cardiac markers) and the use of treatments recommended by the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for management of NSTE ACS. The ultimate goal of the CRUSADE initiative is to improve the quality of compassionate among high-risk patients with NSTE ACS. At the same measure the CRUSADE initiative provides the unique opportunity to evaluate the pattern of NSTE ACS management in a large-scale routine practice setting in the United States. Cumulatively the advertise initiative has collected data from >165,000 patients with NSTE ACS admitted at >400 US hospitals since 2001. This article reviews the study results from the advertise initiative on assay stratification gaps in guidelines adherence paradoxical care and the association of guideline adherence with outcomes.
A total of 14.9% of the overall and 10.3% of the non-CABG population underwent transfusion during their hospitalization. Renal insufficiency and advanced age were strongly associated with the likelihood of transfusion. Interhospital transfusion rates varied significantly. Non-CABG patients who received transfusions had a greater risk of death (11.5% vs. 3.8%) and death or reinfarction (13.4% vs. 5.8%) than patients who did not change transfusion.
We designed and applied a hospital cross-sectional analyse to 212 hospitals participating in advertise (Can Rapid assay Stratification of Unstable Angina Patients check Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) a voluntary QI initiative of patients with non–ST-segment elevation acute coronary syndromes (NSTE ACS). We calculate analysis and an ordinary least squares regression copy to cause the key hospital factors most associated with unexpected improvements in institutional QI in the treatment of NSTE ACS.
From 2002 to 2004 the following factors had a significant association with unexpected increases in the 2004 QI in NSTE ACS treatment: the use of CRUSADE QI tools clinical commitment to quality by a cardiology coadvocate institutional financial commitment to quality and barriers to QI related to resource availability and cultural resistance to dress (all P < .10). Of these factors optimal use of CRUSADE QI tools was associated with the highest absolute improvement in affect adherence advance relative to other factors.
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