Quality of care for patients with acute coronary syndromes as a function of hospital revascularization capability: Insights from get with the guidelines-CAD

Abstract

Background: Revascularization availability at US hospitals varies and may impact care quality for acute coronary syndrome patients.

Hypothesis: The hypothesis of this study was that there would be differences in care quality at Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) hospitals based on revascularization capability.

Methods: For acute coronary syndrome patients admitted to GWTG-CAD hospitals between 2000 and 2010, care quality at hospitals with or without revascularization capability was examined by assessing conformity with performance and quality measures.

Results: This study included 95 999 acute coronary syndrome patients admitted to 310 GWTG-CAD hospitals. There were 89 000 patients admitted to 226 revascularization-capable hospitals and 6999 patients admitted to 84 hospitals without revascularization capability included. Adjusted multivariate analysis demonstrated that 8 of the 19 measures were more frequently performed in the revascularization cohort: aspirin (odds ratio [OR]: 1.41, 95% confidence interval [CI]: 1.04-1.92), clopidogrel (OR: 2.31, 95% CI: 1.78-3.00), lipid-lowering therapies at discharge (OR: 1.39, 95% CI: 1.04-1.87), lipid-lowering therapies for low-density lipoprotein >100 mg/dL (OR: 1.85, 95% CI: 1.23-2.77), achievement of blood pressure <140/90 mm Hg (OR: 1.20, 95% CI: 1.03-1.40), LDL recorded (OR: 1.47, 95% CI: 1.05-2.06), and recommendations offered for physical activity (OR: 3.82, 95% CI: 2.23-6.55) or weight management (OR: 1.74, 95% CI: 1.12-2.69).

Conclusions: The GWTG-CAD revascularization hospitals were associated with better performance in some, but not all, measures assessed. Although the difference in conformity between hospital types was modest for performance measures but more variable for quality measures, room for improvement exists in key aspects of care.

Figure 1

Percent conformity with performance measures for ACS patients admitted to GWTG hospitals with or without on‐site revascularization capability. Abbreviations: ACE, angiotensin‐converting enzyme inhibitor; ACS, acute coronary syndrome; ARB, angiotensin receptor blocker; BB, β‐blocker; GWTG, Get With The Guidelines; LDL, low‐density lipoprotein cholesterol; LVSD, left ventricular systolic dysfunction.

Figure 2

Percent conformity with quality measures for ACS patients admitted to GWTG hospitals with or without on‐site revascularization capability. Abbreviations: ACE, angiotensin‐converting enzyme inhibitor; AMI, acute myocardial infarction; ARB, angiotensin receptor blocker; BB, β‐blocker; DBP, diastolic blood pressure; DM, diabetes mellitus; LDL, low‐density lipoprotein cholesterol; recs., recommendations; SBP, systolic blood pressure; weight mgmt., weight management.