02674nas a2200265   4500000000100000008004100001100002300042700001500065700001500080700001700095700001200112700001100124700001200135700001200147700001200159700001300171700001300184700001800197245023400215250001500449300001500464490000800479520187000487020005102357       2015                            d1 aAliprandi-Costa B.1 aBrieger D.1 aAntonis P.1 aCoverdale S.1 aHung J.1 aLau J.1 aCass A.1 aHyun K.1 aChew D.1 aFerry C.1 aDabin B.1 aAnastasius M.00aEvidence-based care in a population with chronic kidney disease and acute coronary syndrome. Findings from the Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events (CONCORDANCE)  a2015/09/20  a566-572 e10 v1703 a<p>
BACKGROUND: Acute coronary syndrome (ACS) guidelines recommend that patients with chronic kidney disease (CKD) be offered the same therapies as other high-risk ACS patients with normal renal function. Our objective was to describe the gaps in evidence-based care offered to patients with ACS and concomitant CKD. METHODS: Patients presenting to 41 Australian hospitals with suspected ACS were stratified by presence of CKD (glomerular filtration rate &lt;60 mL/min). Receipt of evidence-based care including, coronary angiography (CA), evidence-based discharge medications (EBMs), and cardiac rehabilitation (CR) referral, were compared between patients with and without CKD. Hospital and clinical factors that predicted receipt of care were determined using multilevel multivariable stepwise logistic regression models. RESULTS: Of the 4,778 patients admitted with suspected ACS, 1,227 had CKD. On univariate analyses, patients with CKD were less likely to undergo CA (59.1% vs 85.0%, P &lt; .0001) or receive EBM (69.4% vs 78.7%, P &lt; .0001), or were offered CR (49.5% vs 68.0%, P &lt; .0001). After adjusting for patient characteristics and clustering by hospital, CKD remained an independent predictor of not undergoing CA only (odds ratio 0.48, 95% CI 0.37-0.61). Within the CKD cohort, presenting to a hospital with a catheterization laboratory was the strongest predictor of undergoing CA (odds ratio 3.07, 95% CI 1.91-4.93). CONCLUSION: The presence of CKD independently predicts failure to undergo CA but not failure to receive EBM or CR, which is predicted by comorbidities. Among the CKD population, performance of CA is largely determined by admission to a catheterization capable hospital. Targeting these patients through standardization of care across institutions offers opportunities to improve outcomes in this high-risk population.
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  a1097-6744 (Electronic)<br/>0002-8703 (Linking)