TY - JOUR
T1 - Regional Outcomes After Admission for High-Risk Non-ST-Segment Elevation Acute Coronary Syndromes
AU - Menon, Venu
AU - Rumsfeld, John S.
AU - Roe, Matthew T.
AU - Cohen, Mauricio G.
AU - Peterson, Eric D.
AU - Brindis, Ralph G.
AU - Chen, Anita Y.
AU - Pollack, Charles V.
AU - Smith, Sidney C.
AU - Gibler, W. Brian
AU - Ohman, E. Magnus
N1 - Funding Information:
CRUSADE is a National Quality Improvement Initiative of the Duke Clinical Research Institute. CRUSADE is funded by Millennium Pharmaceuticals, Inc. (Cambridge, Mass) and Schering Corporation (Kenilworth, NJ). Bristol-Myers Squibb (Plainsboro, NJ)/Sanofi Pharmaceuticals (New York, NY) Partnership provides additional funding support.
PY - 2006/7
Y1 - 2006/7
N2 - Purpose: An analysis of reginal variation across the United States in the treatment and outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) has not been previously performed. Subjects and Methods: We assessed contemporary practice and outcomes in 56,466 high-risk patients with NSTE ACS (positive cardiac markers and/or ischemic ST-segment changes) admitted to 310 hospitals across four defined regions in the United States from January 1, 2001, to September 30, 2003. Patient clinical characteristics, acute (<24 hours) and discharge medications, in-hospital procedures, and in-hospital case-fatality rates were evaluated. Results: Statistically significant but clinically small differences in baseline characteristics including age, gender, rates of diabetes, hypertension, and smoking, as well as medical treatment, including a greater than 5% variation in acute use of beta-blockers, clopidogrel, and statins use, were noted across regions. Adjusted rates of revascularization were similar across regions. Overall in-hospital case-fatality rate was 4.1%, with the highest rates in the Midwest (4.6%) and the lowest in the Northeast (3.5%). Adjusted odds ratios (OR) (95% confidence interval [CI] for death were significantly higher in the Midwest (OR 1.42, CI 1.19-1.70), West (OR 1.40 CI 1.05-1.87), and South (OR 1.33, CI 1.08-1.62), compared with the Northeast. Conclusions: Management of high-risk patients with NSTE ACS is relatively uniform across the United States. However, in-hospital case-fatality rates vary significantly by region, and the differences are not explained by adjustment for standard clinical variables.
AB - Purpose: An analysis of reginal variation across the United States in the treatment and outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) has not been previously performed. Subjects and Methods: We assessed contemporary practice and outcomes in 56,466 high-risk patients with NSTE ACS (positive cardiac markers and/or ischemic ST-segment changes) admitted to 310 hospitals across four defined regions in the United States from January 1, 2001, to September 30, 2003. Patient clinical characteristics, acute (<24 hours) and discharge medications, in-hospital procedures, and in-hospital case-fatality rates were evaluated. Results: Statistically significant but clinically small differences in baseline characteristics including age, gender, rates of diabetes, hypertension, and smoking, as well as medical treatment, including a greater than 5% variation in acute use of beta-blockers, clopidogrel, and statins use, were noted across regions. Adjusted rates of revascularization were similar across regions. Overall in-hospital case-fatality rate was 4.1%, with the highest rates in the Midwest (4.6%) and the lowest in the Northeast (3.5%). Adjusted odds ratios (OR) (95% confidence interval [CI] for death were significantly higher in the Midwest (OR 1.42, CI 1.19-1.70), West (OR 1.40 CI 1.05-1.87), and South (OR 1.33, CI 1.08-1.62), compared with the Northeast. Conclusions: Management of high-risk patients with NSTE ACS is relatively uniform across the United States. However, in-hospital case-fatality rates vary significantly by region, and the differences are not explained by adjustment for standard clinical variables.
KW - Acute coronary syndromes
KW - Non-ST elevation myocardial infarction
KW - Outcomes
KW - Regional variation
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U2 - 10.1016/j.amjmed.2006.01.018
DO - 10.1016/j.amjmed.2006.01.018
M3 - Article
C2 - 16828630
AN - SCOPUS:33745880091
SN - 0002-9343
VL - 119
SP - 584
EP - 590
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 7
ER -