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Program increased guideline adherence for patients with STEMI, non-STEMI
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Hospitals participating in the Get with the Guidelines-Coronary Artery Disease program had high adherence with guideline-based medical therapy for patients with STEMI and non-STEMI, study results indicated.
Researchers reviewed registry data of 72,352 patients (48,966 with non-STEMI; 23,386 with STEMI) from 237 US sites between May 2006 and March 2010.
After adjusting for confounding variables, patients with STEMI were more likely to receive aspirin within 24 hours (98.5% vs. 97.1%; adjusted OR=1.63; 95% CI, 1.32-2.02), as well as be discharged on aspirin (98.5% vs. 97.3%; adjusted OR=1.33; 95% CI, 1.19-1.49), beta-blockers (98.2% vs. 96.9%; adjusted OR=1.48; 95% CI, 1.35-1.63) or lipid-lowering medication for LDL levels >100 mg/dL (96.8% vs. 91%; adjusted OR=1.85; 95% CI, 1.61-2.13).
Patients with STEMI were also more likely to receive beta-blockers within 24 hours of hospital arrival (93.9% vs. 90.8%; adjusted OR=1.57; 95% CI, 1.37-1.79) and the following discharge medications: ACE inhibitors or angiotensin receptor blocking agents (85.3% vs. 77.4%; adjusted OR=1.62; 95% CI, 1.51-1.75), clopidogrel (85.6% vs. 67%; adjusted OR=2.42; 95% CI, 2.23-2.61) or lipid-lowering medications (94.8% vs. 88%; adjusted OR=1.71; 95% CI, 1.56-1.86).
Researchers said there was a small difference between those with STEMI compared with those with non-STEMI, and there is still room for further improvement, particularly in the care of those with non-STEMI. Referral bias may account for this because hospitals treating patients with non-STEMI were smaller and less likely to be academic medical centers. They also found that patients with STEMI were more likely to be transferred to larger facilities.
“This higher rate of guideline adherence in our data, compared with older studies, is encouraging and may suggest that compliance with guideline-based therapy has improved significantly over the past several years across the nation,” the researchers wrote.
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