slide1
Download
Skip this Video
Download Presentation
Management of Patients with NSTE ACS Latest Insights from CRUSADE A National Quality Improvement Initiative

Loading in 2 Seconds...

play fullscreen
1 / 23

Management of Patients with NSTE ACS Latest Insights from CRUSADE A National Quality Improvement Initiative - PowerPoint PPT Presentation


  • 119 Views
  • Uploaded on

Management of Patients with NSTE ACS Latest Insights from CRUSADE A National Quality Improvement Initiative. Eric D. Peterson, MD, MPH Duke Clinical Research Institute Duke University Medical Center Durham, North Carolina. Author Disclosures: Research and speaker support from

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Management of Patients with NSTE ACS Latest Insights from CRUSADE A National Quality Improvement Initiative' - jed


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

Management of Patients with NSTE ACSLatest Insights from CRUSADE A National Quality Improvement Initiative

Eric D. Peterson, MD, MPHDuke Clinical Research InstituteDuke University Medical CenterDurham, North Carolina

Author Disclosures: Research and speaker support from

Millennium, Schering Plough, BMS, Sanofi.

goals for crusade improve adherence to acc aha guidelines improve patient outcomes
Aspirin

Clopidogrel

Beta Blocker

Heparin (UFH or LMWH)

GP IIb-IIIa Inhibitor

Cath/PCI

Aspirin

Clopidogrel

Beta Blocker

ACE Inhibitor

Statin/Lipid Lowering

Smoking Cessation

Cardiac Rehabilitation

Goals for CRUSADEImprove Adherence to ACC/AHA Guidelines Improve Patient Outcomes

Acute Therapy

Discharge Therapy

2002 ACC/AHA Guidelines Update

slide3
CRUSADE Site Distribution

Sites Who Have Submitted = 486

WA

(8)

ME

(1)

VT (1)

ND

(1)

MT

(0)

MI

NH (2)

MN

(4)

NY

(36)

OR

(5)

MA (11)

WI

(5)

SD

(2)

RI (1)

ID

(0)

MI

(24)

WY

(0)

CT (8)

PA

(39)

IA

(4)

NJ (10)

NE (4)

OH

(30)

DE (3)

NV

(3)

IL

(15)

IN

(9)

WV

(3)

MD (13)

VA

(16)

UT

(1)

CO

(8)

KY

(8)

MO

(12)

KS

(3)

DC (1)

CA

(36)

NC

(13)

TN

(15)

SC

(6)

OK

(8)

AR

(4)

AZ

(9)

NM

(2)

AL

(11)

GA

(15)

MS

(7)

LA

(8)

TX

(17)

FL

(33)

AK

(0)

HI (1)

Last updated: 1/28/05

representation of elderly community vs rct population
CRUSADE

GRACE

VIGOUR RCT’s

Representation of ElderlyCommunity vs. RCT Population

% Age >75

Decade

Lee, JAMA, 2001

gender and age nste acs
Gender and Age: NSTE ACS

% of population

Patient Age

creatinine clearance and age vigour trials and crusade
Creatinine Clearance and AgeVIGOUR Trials and CRUSADE

Median Creatinine Clearance*

Patient Age (Yrs)

acute medication use q3 2004 within 1st 24 hours in patients without contraindications
Acute Medication Use – Q3 2004(Within 1st 24 hours in patients without contraindications)

96%

100%

91%

88%

80%

55%

60%

46%

40%

20%

0%

Beta

Blockers

Heparin

(LMW + UFH)

GP IIb-IIIa

Inhibitors

Clopidogrel

ASA

Q4 2004 CRUSADE data

trends in acute therapy adherence among patients without contraindications
Trends in Acute Therapy Adherence (Among Patients Without Contraindications)

Quarter 1, 2002 through Quarter 4, 2004

slide11
Invasive Cardiac Procedures – Q4 2004(Among Patients Without Contraindications to Cath)

90%

82%

75%

75%

61%

60%

60%

52%

45%

45%

40%

55%

30%

30%

12%

15%

15%

0%

0%

Cath

Cath

Cath < 48 hr

Cath < 48 hr

PCI

PCI

PCI < 48 hr

PCI < 48 hr

CABG

CABG

Q4 2004 CRUSADE Data

trends in invasive procedure use among patients without contraindications to cath
Trends in Invasive Procedure Use (Among Patients Without Contraindications to Cath)

Quarter 1, 2002 through Quarter 4, 2004

discharge medication use q4 2004 in patients without contraindications
Discharge Medication Use – Q4 2004 (In patients without contraindications)

100%

94%

91%

88%

80%

72%

69%

60%

40%

20%

0%

ASA

Beta Blockers

ACE-

or ARB*

Any Lipid-

Lowering

Agent#

Clopidogrel

*LVEF < 40%, CHF, DM, HTN# Known hyperlipidemia,  TC, LDL

trends in discharge therapy among patients without contraindications
Trends in Discharge Therapy(Among Patients Without Contraindications)

Quarter 1, 2002 through Quarter 4, 2004

overall adherence trends over time quarter 1 2002 quarter 3 2004
Overall Adherence Trends Over Time Quarter 1, 2002 – Quarter 3, 2004

Quarter 1, 2002 through Quarter 4, 2004

does it matter mortality rates by of acute guideline recommended therapies received
Does it Matter? Mortality Rates by # of Acute Guideline Recommended Therapies Received

Adjusted OR: 0.72 (0.68,0.76)

% In-hospital Mortality

Number of Recommended Therapies *

Therapies = Acute Aspirin, Acute Beta-blockers, Acute Heparin, GP IIb/IIIa inhibitors, Cardiac Catheterization <48 hours

mortality rates by of acute guideline recommended therapies received by age group
Mortality Rates by # of Acute Guideline Recommended Therapies Received by Age Group

Age Group

Adj. OR*

0.71(0.67,0.75)0.79 (0.75,0.83)

% In-hospital Mortality

Number of Recommended Therapies *

Therapies = Acute Aspirin, Acute Beta-blockers, Acute Heparin, GP IIb/IIIa inhibitors, Cardiac Catheterization <48 hours

mortality rates by of acute guideline recommended therapies received by risk group
Mortality Rates by # of Acute Guideline Recommended Therapies Received by Risk Group

Risk Group

% In-hospital Mortality

Number of Recommended Therapies *

Therapies = Acute Aspirin, Acute Beta-blockers, Acute Heparin, GP IIb/IIIa inhibitors, Cardiac Catheterization <48 hours; Based on CRUSADE Risk Score

latest results in nste acs in us conclusions
Latest Results in NSTE ACS in US Conclusions
  • Crusade continues to represent ‘real world’ NST ACS
    • Older patients
    • More comorbidity
  • Care for NSTE ACS is improving:
    • Continued progress in adherence to ACC/AHA Guidelines for both acute and discharge treatments
    • More early cath, leading to earlier discharge
  • Yet opportunities for improvement persist
    • Largest gaps: acute GP IIb/IIIa, D/C ACE, clopidogrel
    • “Right dosing” to reduce adverse events
  • And can lead to even better patient outcomes!
ad