Optimal in-hospital and discharge medical therapy in acute coronary syndromes in Kerala: results from the Kerala acute coronary syndrome registry

In-hospital and postdischarge treatment rates for acute coronary syndrome (ACS) remain low in India. However, little is known about the prevalence and associations of the package of optimal ACS medical care in India. Our objective was to define the prevalence, associations, and impact of optimal in-...

Full description

Saved in:

Bibliographic Details
Published in:	Circulation Cardiovascular quality and outcomes Vol. 6; no. 4; pp. 436 - 443
Main Authors:	Huffman, Mark D, Prabhakaran, Dorairaj, Abraham, Adangapuram Kurien, Krishnan, Mangalath Narayanan, Nambiar, Asokan Cheviri, Mohanan, Padinhare Purayil
Format:	Journal Article
Language:	English
Published:	United States 01-07-2013
Subjects:	Acute Coronary Syndrome - drug therapy Acute Coronary Syndrome - mortality Aged Cardiology Service, Hospital - standards Cardiovascular Agents - therapeutic use Chi-Square Distribution Continuity of Patient Care - standards Female Guideline Adherence Hospital Mortality Humans India Logistic Models Male Middle Aged Odds Ratio Patient Admission - standards Patient Discharge - standards Practice Guidelines as Topic Practice Patterns, Physicians' - standards Quality Improvement Quality Indicators, Health Care - standards Registries Risk Factors Treatment Outcome India acute coronary syndrome registries health policy and outcome research
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	In-hospital and postdischarge treatment rates for acute coronary syndrome (ACS) remain low in India. However, little is known about the prevalence and associations of the package of optimal ACS medical care in India. Our objective was to define the prevalence, associations, and impact of optimal in-hospital and discharge medical therapy in the Kerala ACS Registry of 25,718 admissions. We defined optimal in-hospital ACS medical therapy as receiving the following 5 medications: aspirin, clopidogrel, heparin, β-blocker, and statin. We defined optimal discharge ACS medical therapy as receiving all of the above therapies except heparin. Comparisons by optimal versus nonoptimal ACS care were made via Student t test for continuous variables and χ(2) test for categorical variables. We created random effects logistic regression models to evaluate the association between Global Registry of Acute Coronary Events risk score variables and optimal in-hospital or discharge medical therapy. Optimal in-hospital and discharge medical care were delivered in 40% and 46% of admissions, respectively. Wide variability in both in-hospital and discharge medical care was present, with few hospitals reaching consistently high (>90%) levels. Patients receiving optimal in-hospital medical therapy had an adjusted odds ratio (95% confidence interval)=0.93 (0.71, 1.22) for in-hospital death and an adjusted odds ratio (95% confidence interval)=0.79 (0.63, 0.99) for major adverse cardiovascular event rates. Patients who received optimal in-hospital medical care were far more likely to receive optimal discharge care (adjusted odds ratio [95% confidence interval] = 10.48 [9.37, 11.72]). Strategies to improve in-hospital and discharge medical therapy are needed to improve local process-of-care measures and ACS outcomes in Kerala.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1941-7713 1941-7705
DOI:	10.1161/CIRCOUTCOMES.113.000189