April 1, 1998Open Access
View Full PaperTrends in the Quality of Care for Medicare Beneficiaries Admitted to the Hospital With Unstable Angina
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).
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
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.
Main Result
Odds Ratio: 2.3 (95% CI 1.3–4)
Abstract
OBJECTIVES: We sought to 1) determine the proportion of appropriate elderly patients admitted to the hospital with unstable angina who are treated with aspirin and heparin; 2) identify patient factors associated with the Agency for Health Care Policy and Research (AHCPR) guideline-based use of aspirin and heparin; and 3) compare practice patterns and patient outcomes before and after publication of the AHCPR guidelines. BACKGROUND: Improving the care of patients with unstable angina may provide immediate opportunities to mitigate the adverse consequences of unstable angina. However, despite the importance of this diagnosis, there is a paucity of information on the patterns of treatment and outcomes across diverse sites and recent trends in practice that have occurred, especially since the publication of the AHCPR practice guidelines. METHOD: We performed a retrospective cohort study using data created from medical charts and administrative files. The sample included 300 consecutive patients admitted to one of three Connecticut hospitals in the period 1993 to 1994 and 150 consecutive patients admitted in 1995 with a principal discharge diagnosis of unstable angina or chest pain. RESULTS: Of the 384 patients > or =65 years old who had no contraindications to aspirin on hospital admission, 276 (72%) received it. Of the 369 patients > or =65 years old who had no contraindications to heparin on admission, 88 (24%) received it. Among the 321 patients > or =65 years old who had no contraindications to aspirin at hospital discharge, 208 (65%) were prescribed it. When 1995 was compared with 1993 to 1994, the use of aspirin (odds ratio OR 2.3, 95% confidence interval CI 1.3 to 4.0) and heparin (OR 2.8, 95% CI 1.6 to 4.9) on hospital admission significantly increased, and the use of aspirin at discharge (OR 1.4, 95% CI 0.8 to 2.4) increased. Concomitantly, there was a significant reduction in 30-day readmission (OR 0.52, 95% CI 0.27 to 0.99). CONCLUSIONS: Our results indicate an improvement in the care and outcomes of elderly patients with unstable angina, but there remain opportunities for further improvement.
Cite This Study
Krumholz et al. (Wed,) 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).