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.


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

In This Article

Antiplatelet Use by Hospital Type

The CRUSADE initiative specifically included a wide variety of participating sites across the United States, ranging from rural community hospitals to large, tertiary medical centers, to ensure that it accurately reflected real-world approaches to diagnosis and management of unstable angina and NSTEMI. Two analyses of CRUSADE data with respect to early and discharge use of antiplatelet agents in different types of hospitals have been published.[61,62] In the most recent of these analyses, the authors found that academic teaching hospitals, which tend to be located in urban rather than rural areas, had slightly higher rates of adherence to guideline-recommended therapies than did nonacademic community hospitals.[62] Antiplatelet use in the early intervention setting was significantly higher in patients treated at academic hospitals (total of 25,757 patients admitted) than at nonacademic centers (total of 60,285 patients admitted) with regard to aspirin (93.5% vs 91.3, p<0.001) and GP IIb-IIIa inhibitors (38.8% vs 36.4%, p<0.001). At discharge, aspirin use was higher at academic than nonacademic hospitals (92.0% vs 89.5%, p<0.001), whereas clopidogrel use was lower (55.2% vs 56.7%, p<0.001). Overall, nonacademic community hospitals showed more variation than academic hospitals with respect to the use of guideline-recommended therapies for unstable angina and NSTEMI. Nevertheless, significant improvements in quality and consistency of ACS care are required at both academic and nonacademic centers.

Paradoxically, no consistent differences in the use of recommended therapies, or the use and timing of interventional procedures, were found in the other CRUSADE analysis that examined guideline adherence as a function of the population density of participating centers.[61] According to this analysis, quality care in rural America meets or exceeds that seen in more highly populated areas, contrary to the perception that innovations in therapies diffuse slowly from urban to rural health care providers.


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