Journal Wrap | Are quality and safety performance metrics (as assessed by the appropriate dosing of intravenous heparin or low molecular weight heparin or glycoprotein IIb/IIIa inhibitors), individually and in combination, associated with in-hospital patient outcomes among non–ST-elevation acute coronary (NSTE-ACS) patients? This is the question addressed in a recent study published in Circulation.

Study investigators analyzed data from the large national quality improvement initiative, CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association [ACC/AHA] Guidelines). Patients included in CRUSADE had ischemic symptoms at rest within 24 hours prior to presentation and high-risk features that included ST-segment depression, transient ST-segment elevation, and/or positive cardiac biomarkers.

The authors evaluated the use of ACC/AHA 2002 Class I guideline-recommended therapies. Hospital safety performance was assessed with appropriate dosing of intravenous heparin or low molecular weight heparin or glycoprotein IIb/IIIa inhibitors. Hospitals were grouped into four performance quadrants based on guideline adherence rates and antithrombotic dosing safety profile.

Overall results found that among participating patients, the composite median adherence rate for recommended therapies was 85%; the median hospital safe drug-dosing rate was 53%. Correlation between hospital composite adherence and safety metrics was low (r = 0.16, p = 0.008). For every 10% increase in appropriate dosing at a given center, in-hospital mortality odds ratio fell by a corresponding 18% (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.73-0.93). In adjusted analyses, this relationship was attenuated, but persisted. The lowest unadjusted in-hospital mortality was observed in the high adherence and high safety group.

Study investigators concluded that antithrombotic dosing safety provided information on mortality that was complementary to that provided by guideline adherence—an interesting conclusion that draws attention to the need to focus on guideline adherence and dosing safety when considering performance and quality improvement initiatives, according to Prashant Vaishnava, MD.

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Mehta R, Chen A, Alexander K, et al. Circulation. 2015;doi:10.1161/CIRCULATIONAHA.114.013451.

Keywords: CardioSource WorldNews, ACC Publications

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