The adherence of doctors to clinical guidelines for the management of patients with acute coronary syndrome.

In the management of acute coronary syndrome (ACS) adherence to evidence-based clinical guidelines (CG) improves outcomes and reduces healthcare costs. However, in routine practice compliance with CG is often insufficient. The aim of the study was to assess the association of adherence to CG with the length of stay and outcomes ofACS treatment, as well as to identify factors influencing the CG compliance. The study included 464 patients with ACS. The CG adherence was assessed with 9 quality indicators: 1 point was assigned for each positive indicator; total score reflected CG adherence in each case. In ACS with ST elevation (STE-ACS) patients the rate of high CG adherence (8-9 points) was 60.6%, in ACS without ST-elevation (NSTE-ACS) - 51.2%. High CG adherence significantly reduced the 30-day and 6-month mortality in all ACS patients and 12-month mortality in STE-ACS patients. Low CG adherence (1-7 points) was accompanied by the increase by 16.8% the rate ofpatients with length of stay >14 days (OR=1.591, 95% CI: 1.094-2.312) and by 11.4% 1-year readmission for ACS (0R=0.406, 95% CI: 0.239-0.690). On conclusion, doctors ’ adherence to CG for ACS helps to reduce significantly hospital and post-discharge mortality, length of stay and the risk of 1-year read missions for ACS.