Current management of acute coronary syndromes in Australia: observations from the acute coronary syndromes prospective audit

Chew, Derek P.; Amerena, John; Coverdale, Steven; Rankin, James M.; Astley, Carolyn; Brieger, David

doi:10.1111/j.1445-5994.2007.01435.x

Cited by 56 publications

(68 citation statements)

References 22 publications

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“…These secondary prevention strategies have been shown to be critical to management of the underlying disease and prevention of recurrent hospital admission and death [11][12][13] . In spite of the evidence, existing literature indicates that adherence to secondary prevention strategies is suboptimal [12][13][14] . In particular, only about 30% of eligible patients access CR programs in Australia and the United States (US) 15,16 .…”

Section: Introductionmentioning

confidence: 99%

Regular Primary Care Plays a Significant Role in Secondary Prevention of Ischemic Heart Disease in a Western Australian Cohort

et al. 2011

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BACKGROUND: Secondary prevention for established ischaemic heart disease (IHD) involves medication therapy and a healthier lifestyle, but adherence is suboptimal. Simply having scheduled regular appointments with a primary care physician could confer a benefit for IHD patients possibly through increased motivation and awareness, but this has not previously been investigated in the literature. OBJECTIVE: To estimate the association between regular general practitioner (GP) visitation and rates of all-cause death, IHD death or repeat hospitalisation for IHD in older patients in Western Australia (WA). DESIGN: A retrospective cohort design. PARTICIPANTS: Patients aged≥65 years (n=31,841) with a history of hospitalisation for IHD from 1992-2006 were ascertained through routine health data collected on the entire WA population and included in the analysis. MAIN MEASURES: Frequency and regularity of GP visits was determined during a three-year exposure period at commencement of follow-up. A regularity score (range 0-1) measured the regularity of intervals between the GP visits and was divided into quartiles. Patients were then followed for a maximum of 11.5 years for outcome determination. Hazard ratios and 95% confidence intervals were calculated using Cox proportional hazards models. KEY RESULTS: Compared with the least regular quartile, patients with greater GP visit regularity had significantly decreased risks of all-cause death (2 nd least, 2 nd most and most regular: HR=0.76, 0.71 and 0.71); and IHD death (2 nd least, 2 nd most and most regular: HR=0.70, 0.68 and 0.65). Patients in the 2 nd least regular quartile also appeared to experience decreased risk of any repeat IHD hospitalisation (HR=0.83, 95%CI 0.71-0.96) as well as emergency hospitalisation (HR=0.81, 95%CI 0.67-0.98), compared with the least regular quartile. CONCLUSIONS: Some degree of regular GP visitation offers a small but significant protection against morbidity and mortality in older people with established IHD. The findings indicate the importance of scheduled, regular GP visits for the secondary prevention of IHD.KEY WORDS: ischemic heart disease; hospitalisations; GP visits; record linkage; primary care.

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Section: Introductionmentioning

confidence: 99%

Regular Primary Care Plays a Significant Role in Secondary Prevention of Ischemic Heart Disease in a Western Australian Cohort

et al. 2011

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“…8 While it appears that adherence to clinical guidelines is highest among STEMI sufferers, only half of NSTEACS-HR patients underwent guideline-recommended invasive management. 5 This is lower than rates found in other international registries, reflecting not only patient access and preference for treatment, but also lenient risk stratification by decision-making teams. 9 This snapshot of the experience of ACS in Australia highlights an inability to marry current ACS guidelines with risk assessment tools in the clinical approach to ACS.…”

Section: Guidelines Adjuvant Tools and The Australian Experience Of mentioning

confidence: 81%

“…5 The authors identified varying compliance with guideline-recommended pharmacotherapies, reporting higher rates of aspirin and statin use; moderate rates of clopidogrel, beta-blocker and ACE-inhibitor/angiotensin receptor antagonist use; and low rates of glycoprotein IIb/IIIa inhibitor use. Regarding invasive management, the study found suboptimal rates of reperfusion therapy for STEMI across both rural and metropolitan populations.…”

Section: Guidelines Adjuvant Tools and The Australian Experience Of mentioning

confidence: 99%

“…However, perhaps most disconcerting were the relatively low rates of early invasive management for NSTEACS-HR sufferers. 5 Treatment of these high-risk patients is paramount in an effort to combat disease progression and symptomatic presentation and thereby reduce the enormous burden-of-care in terms of morbidity, mortality, and cost of ACS. 8 While it appears that adherence to clinical guidelines is highest among STEMI sufferers, only half of NSTEACS-HR patients underwent guideline-recommended invasive management.…”

Section: Guidelines Adjuvant Tools and The Australian Experience Of mentioning

confidence: 99%

“…5 Unfortunately, this is not always possible. As we have already seen in this paper, evidencebased guidelines are available for the management of ACS, but many inconsistencies exist in their delivery.…”

Section: Treatment Modalities and Clinical Outcomes Of Metropolitan Amentioning

confidence: 99%

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