Your browser doesn't support javascript.
loading
Evidence-based care in a population with chronic kidney disease and acute coronary syndrome. Findings from the Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events (CONCORDANCE).
Lau, Jerrett K; Anastasius, Malcolm O; Hyun, Karice K; Dabin, Bilyana; Coverdale, Steven; Ferry, Cate; Hung, Joseph; Antonis, Paul; Chew, Derek P; Aliprandi-Costa, Bernadette; Cass, Alan; Brieger, David B.
Afiliação
  • Lau JK; Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia.
  • Anastasius MO; Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia.
  • Hyun KK; The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.
  • Dabin B; Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia.
  • Coverdale S; Sunshine Coast Clinical School, University of Queensland, Nambour General Hospital, Nambour, Australia.
  • Ferry C; National Heart Foundation of Australia (New South Wales Division), Phillip, Australia.
  • Hung J; School of Medicine & Pharmacology, Sir Charles Gairdner Hospital Unit. University of Western Australia, Perth, Australia.
  • Antonis P; Department of Cardiology, Monash Medical Centre, Melbourne, Australia.
  • Chew DP; Department of Cardiology, Flinders University, Adelaide, Australia.
  • Aliprandi-Costa B; Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia.
  • Cass A; Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
  • Brieger DB; Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia. Electronic address: david.brieger@sydney.edu.au.
Am Heart J ; 170(3): 566-72.e1, 2015 Sep.
Article em En | MEDLINE | ID: mdl-26385041
BACKGROUND: Acute coronary syndrome (ACS) guidelines recommend that patients with chronic kidney disease (CKD) be offered the same therapies as other high-risk ACS patients with normal renal function. Our objective was to describe the gaps in evidence-based care offered to patients with ACS and concomitant CKD. METHODS: Patients presenting to 41 Australian hospitals with suspected ACS were stratified by presence of CKD (glomerular filtration rate <60 mL/min). Receipt of evidence-based care including, coronary angiography (CA), evidence-based discharge medications (EBMs), and cardiac rehabilitation (CR) referral, were compared between patients with and without CKD. Hospital and clinical factors that predicted receipt of care were determined using multilevel multivariable stepwise logistic regression models. RESULTS: Of the 4,778 patients admitted with suspected ACS, 1,227 had CKD. On univariate analyses, patients with CKD were less likely to undergo CA (59.1% vs 85.0%, P < .0001) or receive EBM (69.4% vs 78.7%, P < .0001), or were offered CR (49.5% vs 68.0%, P < .0001). After adjusting for patient characteristics and clustering by hospital, CKD remained an independent predictor of not undergoing CA only (odds ratio 0.48, 95% CI 0.37-0.61). Within the CKD cohort, presenting to a hospital with a catheterization laboratory was the strongest predictor of undergoing CA (odds ratio 3.07, 95% CI 1.91-4.93). CONCLUSION: The presence of CKD independently predicts failure to undergo CA but not failure to receive EBM or CR, which is predicted by comorbidities. Among the CKD population, performance of CA is largely determined by admission to a catheterization capable hospital. Targeting these patients through standardization of care across institutions offers opportunities to improve outcomes in this high-risk population.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Sistema de Registros / Avaliação de Resultados em Cuidados de Saúde / Medicina Baseada em Evidências / Gerenciamento Clínico / Fidelidade a Diretrizes / Síndrome Coronariana Aguda Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País como assunto: Oceania Idioma: En Ano de publicação: 2015 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Sistema de Registros / Avaliação de Resultados em Cuidados de Saúde / Medicina Baseada em Evidências / Gerenciamento Clínico / Fidelidade a Diretrizes / Síndrome Coronariana Aguda Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged País como assunto: Oceania Idioma: En Ano de publicação: 2015 Tipo de documento: Article