|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 1999; 34:1689-1695 © 1999 by the American College of Cardiology Foundation |
a Section of Cardiology, Rush Presbyterian–St. Luke’s Medical Center, Chicago, Illinois, USA
Manuscript received November 17, 1998; revised manuscript received May 17, 1999, accepted August 5, 1999.
Reprint requests and correspondence: Dr. James E. Calvin, Section of Cardiology, Rush Presbyterian–St. Luke’s Medical Center, 1653 W. Congress Parkway, 214 Jones, Chicago, Illinois 60612-3864
jcalvin{at}rpslmc.edu
OBJECTIVES
To determine the influence of clinical practice guidelines on treatment patterns and clinical outcomes in unstable angina and the effectiveness of guideline reminders on implementing practice guidelines, two groups of medium and high risk patients with unstable angina were compared.
BACKGROUND
New guidelines have been published by the Agency for Health Care Policy and Research (AHCPR) for evaluating and managing patients with unstable angina. The impact of these guidelines to improve the quality of care has never been tested.
METHODS
Group 1 included 338 consecutive medium or high risk patients admitted before publication of the AHCPR guidelines, and group 2 consisted of 181 consecutive similar risk patients admitted after institution of the AHCPR guideline reminders at this institution. Dissemination of clinical practice guidelines was ensured by a grand rounds lecture and by posting guideline reminders on all group 2 patients’ charts within 24 h of admission.
RESULTS
The two groups were similar in terms of most baseline characteristics, including hypercholesterolemia, diabetes, hypertension, smoking history, baseline ST segment depression and previous coronary artery bypass graft surgery. Group 1 patients were older (68 ± 13 vs. 63 ± 16 years, p = 0.001) and more frequently had a previous myocardial infarction (39% vs. 22%, p = 0.001). Group 2 patients more frequently required intravenous nitroglycerin to control the index episode of chest pain (43% vs. 34%, p = 0.003). Group 2 patients more frequently received aspirin (96% vs. 88%, p = 0.009) during admission and underwent coronary angiography (71% vs. 58%, p = 0.006). More importantly, group 2 patients received oral beta-blockers (p = 0.008), aspirin and coronary angiography (p = 0.001) earlier than group 1 patients and experienced recurrent angina (29% vs. 54%) and myocardial infarction or death less frequently (3% vs. 9%, p = 0.028).
CONCLUSIONS
In unstable angina, clinical practice guidelines were associated with greater use of aspirin and coronary angiography and greater use and earlier administration of beta-blockers. Variation in drug use over time was also reduced. Objective improvement in clinical outcome was also noted. Thus, practice guidelines improve the quality of care of patients with unstable angina.
| ||||||||||||
This article has been cited by other articles:
|
|
 |
|
  D. A. Katz, J. Dawson, J. R. Beshansky, P. S. Rahko, T. P. Aufderheide, M. Bogner, H. Tighouart, and H. P. Selker Does Concordance with Guideline Triage Recommendations Affect Clinical Care of Patients with Possible Acute Coronary Syndrome? Med Decis Making, August 1, 2007; 27(4): 423 - 437. [Abstract] [PDF]
|
|
|
|
 |
|
 J. E. Calvin, M. T. Roe, A. Y. Chen, R. H. Mehta, G. X. Brogan Jr., E. R. DeLong, D. J. Fintel, W. B. Gibler, E. M. Ohman, S. C. Smith Jr., et al. Insurance Coverage and Care of Patients with Non-ST-Segment Elevation Acute Coronary Syndromes. Ann Intern Med, November 21, 2006; 145(10): 739 - 748. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Katz, T. P. Aufderheide, M. Bogner, P. R. Rahko, R. L. Brown, L. M. Brown, M. E. Prekker, and H. P. Selker The Impact of Unstable Angina Guidelines in the Triage of Emergency Department Patients with Possible Acute Coronary Syndrome. Med Decis Making, November 1, 2006; 26(6): 606 - 616. [Abstract] [PDF]
|
|
|
|
 |
|
 J J Graham, A Timmis, J Cooper, S Ramdany, A Deaner, K Ranjadayalan, and C Knight Impact of the National Service Framework for coronary heart disease on treatment and outcome of patients with acute coronary syndromes Heart, March 1, 2006; 92(3): 301 - 306. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K.-H. Mak Bridging the practice chasm Eur. Heart J., May 2, 2005; 26(10): 949 - 950. [Full Text] [PDF]
|
|
|
|
 |
|
 J.-B. Wasserfallen, A. Berger, P. Eckert, J.-C. Stauffer, J. Schlaepfer, D. Gillis, J. Cornuz, M.-D. Schaller, L. Kappenberger, and B. Yersin Impact of medical practice guidelines on the assessment of patients with acute coronary syndrome without persistent ST segment elevation Int. J. Qual. Health Care, October 1, 2004; 16(5): 383 - 389. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Goldman and A. J. Kirtane Triage of Patients with Acute Chest Pain and Possible Cardiac Ischemia: The Elusive Search for Diagnostic Perfection Ann Intern Med, December 16, 2003; 139(12): 987 - 995. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. F. Welke, B. J. Boots Miller, K. D. McCoy, T. E. Vaughn, M. M. Ward, S. D. Flach, P. M. Peloso, B. A. Sorofman, T. Tripp-Reimer, and B. N. Doebbeling What Factors Influence Provider Knowledge of a Congestive Heart Failure Guideline in a National Health Care System? American Journal of Medical Quality, May 1, 2003; 18(3): 122 - 127. [Abstract] [PDF]
|
|
|
|
|
|
P. W Armstrong DO GUIDELINES INFLUENCE PRACTICE? Heart, March 1, 2003; 89(3): 349 - 352. [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Geraci and C. K. Haan Effect of beta blockers after coronary artery bypass in postinfarct patients: what can we learn from available literature? Ann. Thorac. Surg., November 1, 2002; 74(5): 1727 - 1732. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. H. Solomon, P. H. Stone, R. J. Glynn, D. A. Ganz, C. M. Gibson, R. Tracy, and J. Avorn Use of risk stratification to identify patients with unstable angina likeliest to benefit from an invasive versus conservative management strategy J. Am. Coll. Cardiol., October 1, 2001; 38(4): 969 - 976. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. Keffer Guidelines and Algorithms: Perceptions of Why and When They Are Successful and How to Improve Them Clin. Chem., August 1, 2001; 47(8): 1563 - 1572. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. E. Calvin, L. W. Klein, E. J. VandenBerg, P. Meyer, and J. E. Parrillo Validated risk stratification model accurately predicts low risk in patients with unstable angina J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1803 - 1808. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A. Katz Risk stratification in unstable angina: the role of clinical prediction models J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1809 - 1811. [Full Text] [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
