Antiplatelet Therapy in Patients with Unstable Angina and Non-ST-Segment-Elevation Myocardial Infarction: Findings from the CRUSADE National Quality Improvement Initiative

Michael B. Bottorff, Pharm.D.; Edith A. Nutescu, Pharm.D.; Sarah Spinler, Pharm.D.

Disclosures

Pharmacotherapy. 2007;27(8):1145-1152. 

In This Article

Antiplatelet Use by Care Provider Specialty

The degree to which the specialty of the primary treating physician influences the provision of care to patients with unstable angina or NSTEMI was investigated by using data from the CRUSADE national registry.[60] A total of 18,985 patients with non−ST-segment-elevation ACS who were treated at 289 hospitals between 2001 and 2002 were evaluated for associations between guideline care processes and in-hospital outcomes by cardiologist versus noncardiologist health care providers. Of these patients, 43% were cared for by noncardiologists; these patients were less likely to receive guideline-recommended treatments and had a significantly higher acute mortality risk than those in the care of a cardiologist. Fewer patients received antiplatelet therapy in the first 24 hours of presentation when the primary treating physician was a noncardiologist versus a cardiologist: aspirin 88% versus 92% (adjusted OR 1.34, 95% CI 1.2−1.5), clopidogrel 26% versus 42% (adjusted OR 1.63, 95% CI 1.5−1.8), and GP IIb-IIIa inhibitors 21% versus 39% (adjusted OR 1.95, 95% CI 1.7−2.2). In-hospital mortality rates were 3.3% and 7.1% (adjusted OR 0.75, 95% CI 0.6−0.9) when care was provided by cardiologists and noncardiologists, respectively.

In a separate analysis of 35,875 patients who came to CRUSADE hospitals between March 31, 2000, and December 31, 2002, women, who encompassed 41% of the registry, were less likely than men to be admitted to the care of a cardiologist (53.4% vs 63.4%).[42] These studies illustrate the need to encourage wider dissemination and adherence to national guidelines by all physician specialties.

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