TRENDS IN THE QUALITY OF CARE FOR MEDICARE BENEFICIARIES ADMITTED TO THE HOSPITAL WITH UNSTABLE ANGINA

Objectives. We sought to I) determine the proportion of appropriate el derly patients admitted to the hospital with unstable angina who are t reated with aspirin and heparin; 2) identify patient factors associate d with the Agency for Health Care Policy and Research (AHCPR) guidelin e-based use of aspirin and heparin; and 3) compare practice patterns a nd patient outcomes before and after publication of the AHCPR guidelin es. Background. Improving the care of patients with unstable angina ma y 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 o utcomes across diverse sites and recent trends in practice that have o ccurred, especially since the publication of the AHCPR practice guidel ines. Methods. We performed a retrospective cohort study using data cr eated from medical charts and administrative files. The sample include d 300 consecutive patients admitted to one of three Connecticut hospit als in the period 1993 to 1994 and 150 consecutive patients admitted i n 1995 with a principal discharge diagnosis of unstable angina or ches t pain. Results. Of the 384 patients greater than or equal to 65 years old who had no contraindications to aspirin on hospital admission, 27 6 (72%) received it. Of the 369 patients greater than or equal to 65 y ears old who had no contraindications to heparin on admission, 88 (24% ) received it. Among the 321 patients greater than or equal to 65 year s old who had no contraindications to aspirin at hospital discharge, 2 08 (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 admis sion significantly increased, and the use of aspirin at discharge (OR 1.4, 95% CI 0.8 to 2.4) increased. Concomitantly, there was a signific ant reduction in 30-day readmission (OR 0.52, 95% CI 0.27 to 0.99). Co nclusions. Our results indicate an improvement in the care and outcome s of elderly patients with unstable angina, but there remain opportuni ties for further improvement. (C)1998 by the American College of Cardi ology.