Association of unstable angina guideline care with improved survival

Citation
Rp. Giugliano et al., Association of unstable angina guideline care with improved survival, ARCH IN MED, 160(12), 2000, pp. 1775-1780
Citations number
17
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Journal title
ARCHIVES OF INTERNAL MEDICINE
ISSN journal
00039926 → ACNP
Volume
160
Issue
12
Year of publication
2000
Pages
1775 - 1780
Database
ISI
SICI code
0003-9926(20000626)160:12<1775:AOUAGC>2.0.ZU;2-M
Abstract
Background: An unstable angina guideline was published in 1994 by the Agenc y for Health Care Policy and Research, Bethesda, Md. However, the relations hip between guideline-concordant care and patient outcomes is unknown. Objective: To determine whether guideline-concordant care is associated wit h improved outcomes. Methods: The study sample consisted of 275 consecutive nonreferral patients hospitalized with primary unstable angina. One-year survival and survival free of myocardial infarction were compared between patients who received c are concordant with 8 selected guideline recommendations and patients who r eceived discordant care. Results: Care concordant with the 8 key guideline recommendations was assoc iated with improved 1-year survival (95% vs 81%; log-rank P<.001) and survi val free of myocardial infarction (91% vs 74%; P<.001), compared with guide line-discordant care. Patients in high risk subgroups had the largest survi val benefit associated with guideline-concordant care (aged greater than or equal to 65 years, 91% vs 74% [P=.005]; heart failure at presentation, 91% vs 68% [P=.10]). Aspirin therapy was the single recommendation most strong ly associated with improved 1-year survival (94% vs 78%; P=.002). Conclusions: Care as outlined in the unstable angina clinical practice guid eline is associated with improved 1-year outcomes. Subgroups of patients at highest risk and recommendations firmly based on randomized clinical trial data were mast strongly associated with better outcomes. These findings su pport the use of an evidence-based approach to guideline development and as sessment of quality of care in patients with primary unstable angina.