TY - JOUR AU - Aliprandi-Costa B. AU - Brieger D. AU - Antonis P. AU - Coverdale S. AU - Hung J. AU - Lau J. AU - Cass A. AU - Hyun K. AU - Chew D. AU - Ferry C. AU - Dabin B. AU - Anastasius M. AB -

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 <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 < .0001) or receive EBM (69.4% vs 78.7%, P < .0001), or were offered CR (49.5% vs 68.0%, P < .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.

AD - Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia.
The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.
Sunshine Coast Clinical School, University of Queensland, Nambour General Hospital, Nambour, Australia.
National Heart Foundation of Australia (New South Wales Division), Phillip, Australia.
School of Medicine & Pharmacology, Sir Charles Gairdner Hospital Unit. University of Western Australia, Perth, Australia.
Department of Cardiology, Monash Medical Centre, Melbourne, Australia.
Department of Cardiology, Flinders University, Adelaide, Australia.
Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia. Electronic address: david.brieger@sydney.edu.au. AN - 26385041 BT - American Heart Journal DP - NLM ET - 2015/09/20 LA - eng LB - AUS
R&M
CDV
FY16 M1 - 3 N1 - Lau, Jerrett K
Anastasius, Malcolm O
Hyun, Karice K
Dabin, Bilyana
Coverdale, Steven
Ferry, Cate
Hung, Joseph
Antonis, Paul
Chew, Derek P
Aliprandi-Costa, Bernadette
Cass, Alan
Brieger, David B
United States
Am Heart J. 2015 Sep;170(3):566-572.e1. doi: 10.1016/j.ahj.2015.06.025. Epub 2015 Jul 8. N2 -

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 <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 < .0001) or receive EBM (69.4% vs 78.7%, P < .0001), or were offered CR (49.5% vs 68.0%, P < .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.

PY - 2015 SN - 1097-6744 (Electronic)
0002-8703 (Linking) SP - 566 EP - 572 e1 T2 - American Heart Journal TI - Evidence-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) VL - 170 Y2 - FY16 ER -