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February 1, 2008The Medical Journal of Australia

Variations in the application of cardiac care in Australia

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Why the study?

Does treatment at centers with interventional facilities improve adherence to clinical practice guidelines in patients presenting with chest pain?

Population

2,380 consecutive patients admitted with chest pain to 27 hospitals across five states in Australia between…

Comparison

Treatment at centres with angiography and… vs Treatment at centres without angiography and…

Design

Cross-sectional

Authors

DWD. WaltersInterventional CardiologyDCDerek P. ChewSouth Australia PathologyLBLinden BungeyMSD (Australia)

Discussion

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Overview

Disparities in angiography referral by center type signal care gaps; leaves open whether interventional access drives guideline adherence or reflects unmeasured factors.

Key Points

  • To evaluate compliance with national clinical practice guidelines for acute coronary syndrome management among patients presenting with chest pain.
  • Prospective cross-sectional case note review of 2380 consecutive patients admitted with chest pain across 27 hospitals in five Australian states between January 2003 and August 2005.
  • Stratified patients into two cohorts based on hospital type: centres with angiography and percutaneous intervention facilities (n = 1260) versus centres lacking these facilities (n = 1120).
  • Substantial delays occurred across hospitals in obtaining electrocardiography, administering thrombolysis, transferring high-risk cases, and performing revascularisation, with underutilisation of medications including glycoprotein IIb/IIIa antagonists.
  • Patients treated at non-interventional facilities were significantly less likely to receive guideline-directed medical therapy and referral for coronary angiography (20.11%) compared to those at interventional facilities (66.43%; P < 0.001).

Structured PICO

Does treatment at centers with interventional facilities improve adherence to clinical practice guidelines in patients presenting with chest pain?

P
Population
2,380 consecutive patients admitted with chest pain to 27 hospitals across five states in Australia between January 2003 and August 2005.
I
Intervention
Treatment at centres with angiography and percutaneous intervention facilities (n = 1260)
C
Comparator
Treatment at centres without angiography and percutaneous intervention facilities (n = 1120)
O
Outcome
Proportion of patients whose care met quality of care standards for diagnostic and risk-stratification procedures and management according to NHF/CSANZ treatment guidelines

There are significant deficits in adherence to evidence-based guidelines for managing chest pain in Australia, with care quality being notably lower in hospitals lacking interventional facilities.

Cite This Study

Walters et al. (2008) studied this question.

synapsesocial.com/papers/6a87db7ff762332bf8fe86afhttps://doi.org/10.5694/j.1326-5377.2008.tb01588.x
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Also Consider

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  1. 1Differences in Cardiac Procedures Among Patients in Metropolitan and Non‐Metropolitan Hospitals in New South Wales After Acute Myocardial Infarction and Angina2000 · 12 citations
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  4. 4Prognostic Value of Noninvasive Risk Stratification in Younger and Older Patients Referred for Evaluation of Suspected Coronary Artery Disease1996 · 16 citations
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