Emergency department factors that predict adherence to American College of Cardiology/American Heart Association guidelines for treatment of patients with non–ST-segment elevation acute coronary syndromes: Results from the CRUSADE initiative

• Published in: Annals of emergency medicine 2004-10, Vol.44 (4), p.S46-S46
• Main Authors: Miller, C.D., Patel, Y., Lytle, B.L., Chen, A.Y., Gibler, W.B., Ohman, E.M., Peterson, C.V., Roe, M.T., Peterson, E.D., Hoekstra, J.W.
• Format: Article
• Language: English
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2004.07.150

Study objectives: Compliance with the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for the treatment of patients with non–ST-segment elevation acute coronary syndromes (NSTE ACS) is associated with improved outcomes. We sought to identify factors in the emergency department (ED) structure and care delivery processes associated with improved compliance with the ACC/AHA guidelines. Methods: A survey was administered to 317 hospitals participating in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) Quality Improvement Initiative. Surveys were self-administered or conducted by telephone with the emergency physician and nurse coordinator from each site. A composite endpoint of adherence to ACC/AHA class I and II acute care (within 24 hours) guidelines for treatment of patients with NSTE ACS was determined for each site. To determine predictors of guidelines adherence, a multivariate model was used to correlate ED survey responses to ACC/AHA guidelines adherence. Results: A total of 136 sites returned surveys from emergency physicians and nurse coordinators. From these sites, there were 20,856 patient encounters between January 2002 and June 2003 included in the CRUSADE database. Adherence with ACC/AHA guidelines was associated with improved inhospital mortality at participating sites (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.60 to 0.92). The survey identified factors associated with improved guidelines adherence that include the following: administration commitment to quality insurance (OR 1.62, 95% CI 1.49 to 1.76), collaboration between ED and hospital administration (OR 1.16, 95% CI 1.05 to 1.29), sufficient ED time to evaluate patients (OR 1.08, 95% CI 1.03 to 1.13), and identified algorithm for NSTE ACS care (OR 1.05, 95% CI 1.01 to 1.10). Conclusion: ACC/AHA guidelines adherence correlates well with NSTE ACS patient outcomes. Factors that influence the care delivery process, including ED and hospital administrative commitment to quality assurance, affect adherence to treatment guidelines and subsequent mortality in the care of patients with NSTE ACS.