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May 3, 2016European Heart Journal Acute Cardiovascular CareOpen Access

Excess mortality and guideline-indicated care following non-ST-elevation myocardial infarction

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Why the study?

Does non-adherence to guideline-indicated care reduce survival in patients with NSTEMI?

Population

389,057 patients with non-ST-elevation myocardial infarction from 247 hospitals in England and Wales

Comparison

Non-adherence to guideline-indicated care vs Adherence to guideline-indicated care

Design

Cohort

Follow-up

median 2.2 years

Authors

TDTatendashe B DondoMHMarlous HallATAdam Timmis

Discussion

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Overview

Missed guideline interventions were associated with shorter NSTEMI survival; supports quality improvement efforts but leaves causal effects open.

Structured PICO

Does non-adherence to guideline-indicated care reduce survival in patients with NSTEMI?

P
Population
389,057 patients with non-ST-elevation myocardial infarction (NSTEMI) from 247 hospitals in England and Wales (2003-2013)
I
Intervention
Non-adherence to guideline-indicated care (missing one or more eligible interventions such as dietary advice, smoking cessation advice, P2Y12 inhibitors, coronary angiography, cardiac rehabilitation, or statins)
C
Comparator
Adherence to guideline-indicated care
O
Outcome
Survival (mortality)hard clinical

The majority of NSTEMI patients miss at least one guideline-indicated intervention, which is significantly associated with excess mortality and highlights a major opportunity to prevent premature cardiovascular deaths.

Cite This Study

Dondo et al. (2016) studied this question.

synapsesocial.com/papers/6a7cb32cb7ca9b673b7cd2c6https://doi.org/10.1177/2048872616647705
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Mortality and missed opportunities along the pathway of care for ST-elevation myocardial infarction: a national cohort study2014 · 35 citations
  2. 2Long term survival after evidence based treatment of acute myocardial infarction and revascularisation: follow-up of population based Perth MONICA cohort, 1984-20052009 · 109 citations
  3. 3Excess Dosing of Antiplatelet and Antithrombin Agents in the Treatment of Non–ST-Segment Elevation Acute Coronary Syndromes2005 · 678 citations
  4. 4Evaluation of the NICE mini-GRACE risk scores for acute myocardial infarction using the Myocardial Ischaemia National Audit Project (MINAP) 2003–2009: National Institute for Cardiovascular Outcomes Research (NICOR)2012 · 80 citations
  5. 5The Myocardial Ischaemia National Audit Project (MINAP)2010 · 300 citations