Quality of care among elderly patients hospitalized with unstable angina

Background Guidelines for the management of unstable angina have been publi shed by the United States Agency for Health Care Policy and Research (curre ntly known as the Agency for Healthcare Research and Quality); however, lit tle information is available about the quality of unstable angina care, par ticularly among elderly patients. Methods We examined 1196 elderly Medicare-insured patients hospitalized wit h unstable angina (ruled out for acute myocardial infarction) at Connecticu t hospitals between August and November 1995 to evaluate quality of care pr ovided during hospitalization. Patients without therapeutic contra indicati ons were evaluated for the use of 5 Agency for Health Care Policy and Resea rch guideline-recommended measures: electrocardiographic examination within 20 minutes of admission, use of aspirin on admission, intravenous heparin on admission, achievement of therapeutic anticoagulation among patients pro vided heparin, and prescription of aspirin on discharge. Results Less than half (49.6%) of patients underwent electrocardiographic e xamination within 20 minutes of admission. After excluding patients with co ntra indications, aspirin was provided to 80.1% of patients and intravenous heparin to 59.2% of indicated patients, of whom only 43.3% achieved therap eutic anticoagulation. Aspirin was prescribed to 82.3% of eligible patients at discharge. Performance on the 5 quality measures varied widely among ho spitals. Conclusions Agency for Health Care Policy and Research guideline-recommende d risk stratification and therapeutic interventions are underused in elderl y patients hospitalized with unstable angina, with quality of care varying widely among hospitals.