Background:
It is known that closer adherence to clinical guidelines for management of acute coronary syndrome (ACS) is associated with better outcomes. Despite financial and organizational efforts only a small reduction of ACS mortality has been achieved in Russia during recent years. Official statistic data does not allow to evaluate the association of outcomes with quality of ACS treatment. AIM of the analysis was to assess quality of treatment (determined as conformity with guidelines) in patients with non-ST elevation ACS (NSTEACS) in Russian hospitals based on the data of the RECORD-3 registry.
Methods:
The ACS registry RECORD-3 was prospective observational study in which consecutive patients with ACS admitted to 47 hospitals from 37 cities were included within 1 month (Mar-Apr 2015). Recommendations of IA and IB classes from 2015 European society of cardiology guidelines (n=15) were used for evaluation of quality of treatment. The number of applicable recommendations (from 8 to 15) and the rate of their implementation were calculated for each patient. The 3-rd-4-th quartiles of implementation were named “guideline conforming treatment” (GCT), and 1-st and 2-nd quartiles - “guideline non-conforming treatment” (GNT).
Results:
Among 2370 included patients, 1502 (63.4%) had NSTEACS. The median of implementation of recommendations was 63.6% (1-3 quartiles 54.5% - 72.7%). Portions of patients with 100%, >75% and <50% implementation of recommendations were 1.4%, 19.0%, and 14.6%, respectively. During hospitalization (median 10 days) 7 patients (1.0%) receiving “GCT” and 30 patients (3.7%) receiving “GNT” died (relative risk 3.65, 95% confidence interval 1.61-8.26; p=0.0015). At multifactorial regression analysis, independent predictors of “GNT” were: Killip class IV, hospitalization without an ambulance assistance and admission to “noninvasive” hospital, previous atrial fibrillation, absence of ST-depression on first ECG, normal troponin level, first glucose level ≤6.0 mmol/l, not using aspirin or ACE-inhibitor regularly before ACS.
Conclusions:
The analysis of Russian registry RECORD-3 data showed that in participating hospitals >75% of recommendations of IA and IB classes were implemented only in 19% of NSTEACS patients. Hospital mortality was significantly higher in patients with “GNT”. Independent predictors of “GNT” were Killip class IV, hospitalization without an ambulance assistance and admission to “noninvasive” hospital, previous atrial fibrillation, absence of ST-depression, normal troponin or glucose levels, lack of aspirin or ACE-inhibitor regular use before ACS.
The quality of treatment of patients with atrial fibrillation, depending on the index of polymorbidity, preceded hospitalization for acute coronary syndrome