Adherence to Cardiac Practice Guidelines in the Management of Non-ST-Elevation Acute Coronary Syndromes: A Systematic Literature Review

Engel, Josien; Damen, Nikki L.; Wulp, Ineke van der; Bruijne, M.C. de; Wagner, Cordula

doi:10.2174/1573403x12666160504100025

Cited by 29 publications

(39 citation statements)

References 79 publications

(231 reference statements)

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“…Adherence to guideline recommendations for the management of patients with NSTEMI varies widely, as demonstrated in a systematic review of 45 studies conducted around the world; showing adherence rates varying within and across studies from approximately 5.0% to 95.0% for recommended pharmacological treatment, and from 16.0% to 95.8% for coronary angiography . Factors related to lower adherence to guideline recommendations included patients being of older age, female gender, presence of comorbidities, not having a cardiologist as their primary care provider and being treated in a hospital with no PCI/CABG facilities; having no health insurance was related to lower rates of coronary angiography but not medication prescription rates.…”

Section: Challenges For the Treatment Of Patients With Nstemimentioning

confidence: 99%

Invasive and antiplatelet treatment of patients with non‐ST‐segment elevation myocardial infarction: Understanding and addressing the global risk‐treatment paradox

Ahrens

Zúñiga

et al. 2019

Clinical Cardiology

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Clinical guidelines for the treatment of patients with non‐ST‐segment elevation myocardial infarction (NSTEMI) recommend an invasive strategy with cardiac catheterization, revascularization when clinically appropriate, and initiation of dual antiplatelet therapy regardless of whether the patient receives revascularization. However, although patients with NSTEMI have a higher long‐term mortality risk than patients with ST‐segment elevation myocardial infarction (STEMI), they are often treated less aggressively; with those who have the highest ischemic risk often receiving the least aggressive treatment (the “treatment‐risk paradox”). Here, using evidence gathered from across the world, we examine some reasons behind the suboptimal treatment of patients with NSTEMI, and recommend approaches to address this issue in order to improve the standard of healthcare for this group of patients. The challenges for the treatment of patients with NSTEMI can be categorized into four “P” factors that contribute to poor clinical outcomes: patient characteristics being heterogeneous; physicians underestimating the high ischemic risk compared with bleeding risk; procedure availability; and policy within the healthcare system. To address these challenges, potential approaches include: developing guidelines and protocols that incorporate rigorous definitions of NSTEMI; risk assessment and integrated quality assessment measures; providing education to physicians on the management of long‐term cardiovascular risk in patients with NSTEMI; and making stents and antiplatelet therapies more accessible to patients.

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Section: Challenges For the Treatment Of Patients With Nstemimentioning

confidence: 99%

Invasive and antiplatelet treatment of patients with non‐ST‐segment elevation myocardial infarction: Understanding and addressing the global risk‐treatment paradox

Ahrens

Zúñiga

et al. 2019

Clinical Cardiology

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“…Risk stratification and appropriate risk mitigation strategies are of critical importance to reduce the adverse outcomes after ACS [28]. To that end, the GRACE score remains the most popular method of risk stratification of ACS patients.…”

Section: Discussionmentioning

confidence: 99%

Incremental Prognostic Value of Anemia in Acute Coronary Syndrome from A Rural Hospital in India

Chiwhane

Burchundi

Manakshe

et al. 2020

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Background: Anemia is highly prevalent in low-and middle-income countries, where prevalence of acute coronary syndrome (ACS) is also rising. Evidence indicates that baseline anemia status can prognosticate ACS. However, the Global Registry of Acute Coronary Events (GRACE) score that is popularly used all over the world does not include information on anemia. Objectives: Our objective was to investigate if anemia at admission, along with the GRACE score, improves the prediction of adverse outcomes within 6 months in rural Indian patients of ACS. Methods: We enrolled 200 ACS patients at the Acharya Vinoba Bhave Rural Hospital-a rural, tertiary care hospital in central India. Patients were followed for 6 months for death and major adverse cardiac event (MACE). Improvement in the prediction of adverse events by including anemia in addition to the GRACE score was quantified using area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI) and the net reclassification index (NRI). Results: There were 31 deaths due to MACE and an additional 28 non-fatal MACE events during follow-up. Baseline hemoglobin was strongly and independently associated with both outcomes even after adjusting for a multivariable propensity score. For the outcome of death and death/MACE there was a moderate improvement in the AUC of 1% and 6%, respectively. However, for these outcomes the IDI for baseline hemoglobin was 6% (p = 0.03) and 12% (p << 0.0001), respectively, while the NRI was 0.50 (p = 0.01) and 0.78 (p << 0.0001), respectively. Conclusions: Inclusion of baseline anemia in addition to the GRACE score improves prognostication of ACS patients.

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“…Following an index event (e.g. myocardial infarction) with hospital admission, prescription rates for APT, as part of a secondary preventive strategy, are usually high [4][5][6][7][8][9][10], but do not reach 100%. Age, female sex, race, polypharmacy due to comorbidities, and coding problems (among others) are variables which have been shown to have a negative impact on prescription rates at hospital discharge [11][12][13][14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Prescription Rates for Antiplatelet Therapy (APT) in Coronary Artery Disease (CAD) – What Benchmark are We Aiming at in Continuing Medical Education (CME)?

Hagen

Griebenow

2020

Journal of European CME

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Physicians always aim to improve their patients' health. CME should be designed not only to provide knowledge transfer, but also to influence clinical decision-making and to close performance gaps. In aretrospective study we analysed prescription rates for APT in 254,932 CAD patients (male: 64.4%), treated in atotal of 3,405 practices in 2019 in aDMP in the region of North Rhine, Germany. Analyses were run for the whole study population stratified by sex as well as for subgroups of patients suffering from myocardial infarction/acute coronary syndrome, or who have been treated with percutaneous coronary intervention or bypass surgery. Patients mean age was 72.7 ± 11.2 years (mean ± 1SD), mean duration of DMP participation was 7.2 ± 4.7 years, and mean cumulative number of DMP visits was 27 ± 17. APT prescription rates were 85.0% in male and 78.8% in female CAD patients. In subgroups of male CAD patients APT prescription rates were between 89.7% and 92.8%, in the same subgroups of female CAD patients the corresponding rates were between 87.8% and 92.0%. Rates for amissing APT prescription per practice were between .0044% and .0062% for male and female CAD patients, respectively. Rates for amissing APT prescription per practice and DMP visit were .0002% for both sexes. These results suggest that a DMP can achieve high attainment rates for APT in CAD. To further improve attainment rates, consideration of absolute numbers of eligible patients per practice or physician is probably more appropriate than expression of performance as percentage values. This is especially true if attainment rates show substantial variations between subgroups, if subgroups show substantial variation in size, if attainment rates are already in the magnitude of 80% or higher, and if there are disparities in the evidence base underlying treatment recommendations related to subgroups.

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Adherence to Cardiac Practice Guidelines in the Management of Non-ST-Elevation Acute Coronary Syndromes: A Systematic Literature Review

Cited by 29 publications

References 79 publications

Invasive and antiplatelet treatment of patients with non‐ST‐segment elevation myocardial infarction: Understanding and addressing the global risk‐treatment paradox

Invasive and antiplatelet treatment of patients with non‐ST‐segment elevation myocardial infarction: Understanding and addressing the global risk‐treatment paradox

Incremental Prognostic Value of Anemia in Acute Coronary Syndrome from A Rural Hospital in India

Prescription Rates for Antiplatelet Therapy (APT) in Coronary Artery Disease (CAD) – What Benchmark are We Aiming at in Continuing Medical Education (CME)?

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