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A cross-sectional multicentre study of cardiac risk score use in the management of unstable angina and non-ST-elevation myocardial infarction
OBJECTIVES: Quantitative risk assessment in unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI), by using cardiac risk scores, is recommended in international guidelines. However, a gap between recommended care and actual practice exists, as these instruments seem underused in p...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4663402/ https://www.ncbi.nlm.nih.gov/pubmed/26603242 http://dx.doi.org/10.1136/bmjopen-2015-008523 |
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author | Engel, Josien van der Wulp, Ineke de Bruijne, Martine Wagner, Cordula |
author_facet | Engel, Josien van der Wulp, Ineke de Bruijne, Martine Wagner, Cordula |
author_sort | Engel, Josien |
collection | PubMed |
description | OBJECTIVES: Quantitative risk assessment in unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI), by using cardiac risk scores, is recommended in international guidelines. However, a gap between recommended care and actual practice exists, as these instruments seem underused in practice. The present study aimed to determine the extent of cardiac risk score use and to study factors associated with lower or higher cardiac risk score use. SETTING: 13 hospitals throughout the Netherlands. PARTICIPANTS: A retrospective chart review of 1788 charts of patients with UA and NSTEMI, discharged in 2012. PRIMARY AND SECONDARY OUTCOMES: The extent of cardiac risk score use reflected in a documented risk score outcome in the patient's chart. Factors associated with cardiac risk score use determined by generalised linear mixed models. RESULTS: In 57% (n=1019) of the charts, physicians documented the use of a cardiac risk score. Substantial variation between hospitals was observed (16.7–87%), although this variation could not be explained by the presence of on-site revascularisation facilities or a hospitals’ teaching status. Obese patients (OR=1.49; CI 95%1.03 to 2.15) and former smokers (OR=1.56; CI 95%1.15 to 2.11) were more likely to have a cardiac risk score documented. Risk scores were less likely to be used among patients diagnosed with UA (OR=0.60; CI 95% 0.46 to 0.77), in-hospital resuscitation (OR=0.23; CI 95% 0.09 to 0.64), in-hospital heart failure (OR=0.46; CI 95% 0.27 to 0.76) or tachycardia (OR=0.45; CI 95% 0.26 to 0.75). CONCLUSIONS: Despite recommendations in cardiac guidelines, the use of cardiac risk scores has not been fully implemented in Dutch practice. A substantial number of patients did not have a cardiac risk score documented in their chart. Strategies to improve cardiac risk score use should pay special attention to patient groups in which risk scores were less often documented, as these patients may currently be undertreated. |
format | Online Article Text |
id | pubmed-4663402 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-46634022015-12-03 A cross-sectional multicentre study of cardiac risk score use in the management of unstable angina and non-ST-elevation myocardial infarction Engel, Josien van der Wulp, Ineke de Bruijne, Martine Wagner, Cordula BMJ Open Health Services Research OBJECTIVES: Quantitative risk assessment in unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI), by using cardiac risk scores, is recommended in international guidelines. However, a gap between recommended care and actual practice exists, as these instruments seem underused in practice. The present study aimed to determine the extent of cardiac risk score use and to study factors associated with lower or higher cardiac risk score use. SETTING: 13 hospitals throughout the Netherlands. PARTICIPANTS: A retrospective chart review of 1788 charts of patients with UA and NSTEMI, discharged in 2012. PRIMARY AND SECONDARY OUTCOMES: The extent of cardiac risk score use reflected in a documented risk score outcome in the patient's chart. Factors associated with cardiac risk score use determined by generalised linear mixed models. RESULTS: In 57% (n=1019) of the charts, physicians documented the use of a cardiac risk score. Substantial variation between hospitals was observed (16.7–87%), although this variation could not be explained by the presence of on-site revascularisation facilities or a hospitals’ teaching status. Obese patients (OR=1.49; CI 95%1.03 to 2.15) and former smokers (OR=1.56; CI 95%1.15 to 2.11) were more likely to have a cardiac risk score documented. Risk scores were less likely to be used among patients diagnosed with UA (OR=0.60; CI 95% 0.46 to 0.77), in-hospital resuscitation (OR=0.23; CI 95% 0.09 to 0.64), in-hospital heart failure (OR=0.46; CI 95% 0.27 to 0.76) or tachycardia (OR=0.45; CI 95% 0.26 to 0.75). CONCLUSIONS: Despite recommendations in cardiac guidelines, the use of cardiac risk scores has not been fully implemented in Dutch practice. A substantial number of patients did not have a cardiac risk score documented in their chart. Strategies to improve cardiac risk score use should pay special attention to patient groups in which risk scores were less often documented, as these patients may currently be undertreated. BMJ Publishing Group 2015-11-23 /pmc/articles/PMC4663402/ /pubmed/26603242 http://dx.doi.org/10.1136/bmjopen-2015-008523 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Health Services Research Engel, Josien van der Wulp, Ineke de Bruijne, Martine Wagner, Cordula A cross-sectional multicentre study of cardiac risk score use in the management of unstable angina and non-ST-elevation myocardial infarction |
title | A cross-sectional multicentre study of cardiac risk score use in the management of unstable angina and non-ST-elevation myocardial infarction |
title_full | A cross-sectional multicentre study of cardiac risk score use in the management of unstable angina and non-ST-elevation myocardial infarction |
title_fullStr | A cross-sectional multicentre study of cardiac risk score use in the management of unstable angina and non-ST-elevation myocardial infarction |
title_full_unstemmed | A cross-sectional multicentre study of cardiac risk score use in the management of unstable angina and non-ST-elevation myocardial infarction |
title_short | A cross-sectional multicentre study of cardiac risk score use in the management of unstable angina and non-ST-elevation myocardial infarction |
title_sort | cross-sectional multicentre study of cardiac risk score use in the management of unstable angina and non-st-elevation myocardial infarction |
topic | Health Services Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4663402/ https://www.ncbi.nlm.nih.gov/pubmed/26603242 http://dx.doi.org/10.1136/bmjopen-2015-008523 |
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