Trends in the Quality of Care for Medicare Beneficiaries Admitted to the Hospital With Unstable Angina

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Unstable angina (n=450). Intervention: Admission in 1995 (post-guidelines) vs. Admission in 1993-1994 (pre-guidelines). Primary outcome: Use of aspirin on hospital admission (OR 2.3, 95% CI 1.3 to 4.0).

Harlan M. Krumholz; Daniel M. Philbin; Yun Wang; Viola Vaccarino; Jaime Murillo; Michael L. Therrien; Jeanne V.A. Williams; Martha J. Radford

doi:10.1016/s0735-1097(98)00106-5

April 1, 1998Journal of the American College of CardiologyOpen Access

Trends in the Quality of Care for Medicare Beneficiaries Admitted to the Hospital With Unstable Angina

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Key result

Admission for unstable angina in 1995 versus 1993-1994 was associated with increased aspirin use on admission (OR 2.3; 95% CI 1.3-4.0) and reduced 30-day readmission (OR 0.52; 95% CI 0.27-0.99).

Why the study?

Does admission after AHCPR guideline publication improve guideline-directed medical therapy and reduce readmission in elderly patients with unstable angina?

Key Points

To evaluate the use of aspirin and heparin in elderly patients with unstable angina and compare practice trends before and after AHCPR guidelines were published.
Retrospective cohort study using medical charts and administrative files.
Included 300 patients admitted in 1993 to 1994 and 150 patients in 1995.
Evaluated treatment compliance with AHCPR guidelines.
72% of patients ≥65 years old received aspirin upon admission.
24% of patients ≥65 years old received heparin upon admission.
30-day readmission reduced (OR 0.52, 95% CI 0.27 to 0.99).

Study Design

Type

Cohort (n=450)

Multicenter

Yes

Structured PICO

Does admission after AHCPR guideline publication improve guideline-directed medical therapy and reduce readmission in elderly patients with unstable angina?

P

Population

450 patients admitted with a principal discharge diagnosis of unstable angina or chest pain across three Connecticut hospitals, comparing practices in 1993-1994 versus 1995.

E

Exposure

Admission in 1995 (post-AHCPR guidelines)

C

Comparator

Admission in 1993-1994 (pre-AHCPR guidelines)

O

Outcome

Guideline-based use of aspirin and heparin on hospital admission and discharge

Main Result

Odds Ratio: 2.3 (95% CI 1.3–4)

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Implication

The publication of AHCPR guidelines was associated with increased use of aspirin and heparin and reduced 30-day readmissions in elderly patients with unstable angina.

Abstract

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Cite This Study

Krumholz et al. (1998) conducted a cohort in Unstable angina (n=450). Admission in 1995 (post-guidelines) vs. Admission in 1993-1994 (pre-guidelines) was evaluated on Use of aspirin on hospital admission (OR 2.3, 95% CI 1.3 to 4.0). Admission for unstable angina in 1995 versus 1993-1994 was associated with increased aspirin use on admission (OR 2.3; 95% CI 1.3-4.0) and reduced 30-day readmission (OR 0.52; 95% CI 0.27-0.99).

synapsesocial.com/papers/6a59773b5219d0af894d2347 https://doi.org/10.1016/s0735-1097(98)00106-5

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Trends in the Quality of Care for Medicare Beneficiaries Admitted to the Hospital With Unstable Angina

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Trends in the Quality of Care for Medicare Beneficiaries Admitted to the Hospital With Unstable Angina

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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