Regional Outcomes After Admission for High-Risk Non-ST-Segment Elevation Acute Coronary Syndromes

Venu Menon, John S. Rumsfeld, Matthew T. Roe, Mauricio G Cohen, Eric D. Peterson, Ralph G. Brindis, Anita Y. Chen, Charles V. Pollack, Sidney C. Smith, W. Brian Gibler, E. Magnus Ohman

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)584-590
Number of pages7
JournalAmerican Journal of Medicine
Volume119
Issue number7
DOIs
StatePublished - Jul 1 2006
Externally publishedYes

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Acute Coronary Syndrome
Odds Ratio
Confidence Intervals
clopidogrel
Mortality
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Risk Management
Smoking
Hypertension
Therapeutics

Keywords

  • Acute coronary syndromes
  • Non-ST elevation myocardial infarction
  • Outcomes
  • Regional variation

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Regional Outcomes After Admission for High-Risk Non-ST-Segment Elevation Acute Coronary Syndromes. / Menon, Venu; Rumsfeld, John S.; Roe, Matthew T.; Cohen, Mauricio G; Peterson, Eric D.; Brindis, Ralph G.; Chen, Anita Y.; Pollack, Charles V.; Smith, Sidney C.; Gibler, W. Brian; Ohman, E. Magnus.

In: American Journal of Medicine, Vol. 119, No. 7, 01.07.2006, p. 584-590.

Research output: Contribution to journalArticle

Menon, V, Rumsfeld, JS, Roe, MT, Cohen, MG, Peterson, ED, Brindis, RG, Chen, AY, Pollack, CV, Smith, SC, Gibler, WB & Ohman, EM 2006, 'Regional Outcomes After Admission for High-Risk Non-ST-Segment Elevation Acute Coronary Syndromes', American Journal of Medicine, vol. 119, no. 7, pp. 584-590. https://doi.org/10.1016/j.amjmed.2006.01.018
Menon, Venu ; Rumsfeld, John S. ; Roe, Matthew T. ; Cohen, Mauricio G ; Peterson, Eric D. ; Brindis, Ralph G. ; Chen, Anita Y. ; Pollack, Charles V. ; Smith, Sidney C. ; Gibler, W. Brian ; Ohman, E. Magnus. / Regional Outcomes After Admission for High-Risk Non-ST-Segment Elevation Acute Coronary Syndromes. In: American Journal of Medicine. 2006 ; Vol. 119, No. 7. pp. 584-590.
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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

PY - 2006/7/1

Y1 - 2006/7/1

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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