Decline in Rates of Death and Heart Failure in Acute Coronary Syndromes, 1999-2006

University of Toronto, Toronto, Ontario, Canada
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 06/2007; 297(17):1892-900. DOI: 10.1001/jama.297.17.1892
Source: PubMed


CONTEXT: Randomized trials provide robust evidence for the impact of pharmacological and interventional treatments in patients with ST-segment elevation and non-ST-segment elevation acute coronary syndromes (NSTE ACS), but whether this translates to changes in clinical practice is unknown.
OBJECTIVE: To determine whether changes in hospital management of patients with ST-segment elevation myocardial infarction (STEMI) and NSTE ACS are associated with improvements in clinical outcome.
DESIGN, SETTING AND PATIENTS: In the Global Registry of Acute Coronary Events (GRACE), a multinational cohort study, 44 372 patients with an ACS were enrolled and followed up in 113 hospitals in 14 countries between July 1, 1999, and December 31, 2006.
MAIN OUTCOME MEASURES: Temporal trends in the use of evidence-based pharmacological and interventional therapies; patient outcomes (death, congestive heart failure, pulmonary edema, cardiogenic shock, stroke, myocardial infarction).
RESULTS: Use of pharmacological medications increased over the study period (beta-blockers, statins, angiotensin-converting enzyme inhibitors, thienopyridines with or without percutaneous coronary intervention [PCI], glycoprotein IIb/IIIa inhibitors, low-molecular-weight heparin; all P

Download full-text


Available from: Keith A A Fox
  • Source
    • "Improved management strategies for patients diagnosed with ACS have led to a decrease in mortality rates in the past years [4–6]. For patients with STEMI the strategy progressed from acute pharmacological intervention (thrombolysis) to immediate percutaneous coronary intervention (PCI) [7]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Increasing guideline adherence in the management of acute coronary syndrome (ACS) in hospitals potentially reduces heart failure and mortality. Therefore, an expert panel identified three guideline recommendations as the most important aims for improvement in ACS care, i.e. timely invasive treatment, use of risk scoring instruments and prescription of secondary prevention medication at discharge. Aims This study aims to evaluate in-hospital guideline adherence in the care of patients diagnosed with ACS and to identify associated factors. Methods The study has a cross-sectional design. Data are collected in 13 hospitals in the Netherlands by means of retrospective chart review of patients discharged in 2012 with a diagnosis of ACS. The primary outcomes will be the percentages of patients receiving timely invasive treatment, with a documented cardiac risk score, and with a prescription of the guideline-recommended discharge medication. In addition, factors associated with guideline adherence will be studied using generalised linear (mixed) models. Discussion This study explores guideline adherence in Dutch hospitals in the management of patients diagnosed with ACS, using a data source universally available in hospitals. The results of this study can be informative for professionals involved in ACS care as they facilitate targeted improvement efforts.
    Full-text · Article · Jul 2014 · Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
  • Source
    • "An important cause of AHFS is an acute coronary syndrome. However, improvements in the management of patients with acute coronary syndrome were associated with significant reductions in the rates of new-onset HF and mortality (39). The VALIANT study assessed the incidence of and prognostic factors for HF hospitalization among survivors of high-risk acute myocardial infarction. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Context: Prevalence of patients with heart failure (HF) is increasing in worldwide, and also the number of people with HF traveling long distances is increasing. These patients are more prone to experience problems contributed air travel and needs more attention during flight. However, observational studies about problems of HF patients during flight and appropriated considerations for them are limited. Evidence Acquisition: We evaluated the conditions that may be encountered in a HF patient and provide the recommendations to prevent the exacerbation of cardiac failure during air travel. For this review article, a comprehensive search was undertaken for the studies that evaluated the complications and considerations of HF patients during flight. Data bases searched were: MEDLINE, EMBASE, Science Direct, and Google Scholar. Results: HF patients are more prone to experience respiratory distress, anxiety, stress, cardiac decompensation, and venous thromboembolism (VTE) during air travel. Although stable HF patients can tolerate air travel, but those with acute heart failure syndrome should not fly until complete improvement is achieved. Conclusions: Thus, identifying the HF patients before the flight and providing them proper education about the events that may occur during flight is necessary.
    Full-text · Article · Jun 2014
  • Source
    • "During the last 10 to 15 years, the epidemiological situation in the field of acute coronary syndrome (ACS), which varies by country, has changed [1] [2] [3] [4] [5] [6] [7] [8] [9]. The characteristics of patients admitted for ACS is changing , and the prognosis is improving given the widespread use of evidence-based pharmacological and interventional treatment strategies [3] [10] [11]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The incidence and treatment strategies of acute coronary syndrome (ACS) vary by region. Additionally, the clinical spectrum of ACS is changing and outcomes are improving. Aim We assessed the incidence, treatment strategies, and outcomes of ACS for a well-defined population within a well-established network of percutaneous coronary intervention (PCI) centers and non-PCI centers. Methods The CZECH-2 registry included 1221 consecutive patients (mean age: 68 ± 13 years; 63.4% males) admitted for suspected ACS to 32 hospitals (including 4 PCI centers) within four Czech counties (total population: 2,370,841 inhabitants) during a 2-month period. Results The estimated incidence of confirmed ACS was 2149 cases/million/year. In 374 (31%) patients, ACS was ruled out during the hospital stay. Coronary angiography (CAG) was performed in 60% of the patients overall and PCI was performed in 59% of the confirmed ACS patients. Killip classifications II–IV on admission were more common in patients with final diagnosis of non ST-elevation myocardial infarction (NSTEMI) than ST-elevation myocardial infarction (STEMI) (37.1% vs. 22.8%; p < 0.001). The 30-day mortality rate was 5.7% for the whole study group, 7.3% for STEMI patients, 8.4% for NSTEMI patients, and 1.6% for patients with unstable angina pectoris (UAP), respectively. Conclusions Almost one-third of the patients admitted for suspected ACS had a different final diagnosis. Among those with confirmed ACS, the use of CAG, PCI, CABG, and effective medications is rational. Outcome in NSTEMI patients was equivalent to those in STEMI patients, mainly due to the high-risk population in this group.
    Full-text · Article · May 2014 · International journal of cardiology
Show more