Variations in indicated care of patients with acute coronary syndromes in Queensland hospitals

Scott, Ian A., Duke, Andy B., Darwin, Irene C., Harvey, Kathy H., Jones, Mark A. and CHI Cardiac Collaborative (2005) Variations in indicated care of patients with acute coronary syndromes in Queensland hospitals. Medical Journal of Australia, 182 7: 325-330.

Author Scott, Ian A.
Duke, Andy B.
Darwin, Irene C.
Harvey, Kathy H.
Jones, Mark A.
CHI Cardiac Collaborative
Title Variations in indicated care of patients with acute coronary syndromes in Queensland hospitals
Journal name Medical Journal of Australia   Check publisher's open access policy
ISSN 0025-729X
Publication date 2005-04-04
Sub-type Article (original research)
Volume 182
Issue 7
Start page 325
End page 330
Total pages 6
Place of publication Strawberry Hills, NSW, Australia
Publisher Australasian Medical Publishing Company
Collection year 2005
Language eng
Subject 321003 Cardiology (incl. Cardiovascular Diseases)
730106 Cardiovascular system and diseases
Formatted abstract
To identify variation in the rates of use of key evidence-based therapies and in clinical outcomes among patients hospitalised with acute coronary syndromes (ACS).

Retrospective analysis of data on care processes and clinical outcomes of representative patient samples recorded by the Queensland Health Cardiac Collaborative registry.


18 public hospitals (3 tertiary, 15 non-tertiary) in Queensland, August 2001 to December 2003.

Study population:
2156 patients who died or were discharged after troponin-positive ACS.

Main outcome measures:
Comparison of proportions of highly eligible patients receiving indicated care and in-hospital mortality between subgroups categorised by age, sex, comorbidities (diabetes, renal failure, chronic obstructive pulmonary disease and mental disorder), type of admitting hospital (tertiary or non-tertiary), and cardiologist involvement (transfer or non-transfer to cardiology unit).

Patients aged >= 65 years were less likely than younger patients to receive heparin (79% v 87%), beta-blockers (79% v 87%), lipid-lowering agents (78% v 87%), coronary angiography (51% v 66%), and referral to cardiac rehabilitation (17% v 33%). Patients with diabetes were less likely than others to receive coronary angiography (50% v 63%), while those with moderate to severe renal failure were less likely to receive thrombolysis (52% v 84%), heparin (71% v 83%), beta-blockers (69% v 84%), lipid-lowering agents (61% v 84%), in-hospital cardiac counselling (46% v 64%) and referral to cardiac rehabilitation (9% v 25%). Patients admitted to tertiary hospitals were more likely than those admitted to non-tertiary hospitals to receive coronary angiography (85% v 55%) and referral to cardiac rehabilitation (36% v 21%). Risk-adjusted mortality was highest in patients with moderate to severe renal failure (15% v 3%) and older patients (6% v 2%).

Variations exist in the provision of indicated care to patients with ACS according to age, diabetic status, renal function and type of admitting hospital. Excess mortality in elderly patients and in those with advanced renal disease may be partially attributable to failure to use key therapies.
Keyword Medicine, General & Internal
Acute Myocardial-infarction
Quality-improvement Collaboration
Optimize Cardiac Care
Physician Specialty
National Registry
Public Hospitals
Older Patients
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2006 Higher Education Research Data Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 12 times in Thomson Reuters Web of Science Article | Citations
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Created: Wed, 15 Aug 2007, 05:41:14 EST