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Optimal In-Hospital and Discharge Medical Therapy in Acute Coronary Syndromes in Kerala: Results From the Kerala Acute Coronary Syndrome Registry
Background—In-hospital and postdischarge treatment rates for acute coronary syndrome (ACS) remain low in India. However, little is known about the prevalence and associations of the package of optimal ACS medical care in India. Our objective was to define the prevalence, associations, and impact of...
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| Formato: | Printed Book |
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Circ Cardiovasc Qual Outcomes
2013
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| Acceso en liña: | http://10.26.1.76/ks/005342.pdf |
| Summary: | Background—In-hospital and postdischarge treatment rates for acute coronary syndrome (ACS) remain low in India.
However, little is known about the prevalence and associations of the package of optimal ACS medical care in India. Our
objective was to define the prevalence, associations, and impact of optimal in-hospital and discharge medical therapy in
the Kerala ACS Registry of 25 718 admissions.
Methods and Results—We defined optimal in-hospital ACS medical therapy as receiving the following 5 medications:
aspirin, clopidogrel, heparin, β-blocker, and statin. We defined optimal discharge ACS medical therapy as receiving all
of the above therapies except heparin. Comparisons by optimal versus nonoptimal ACS care were made via Student t
test for continuous variables and χ 2 test for categorical variables. We created random effects logistic regression models to
evaluate the association between Global Registry of Acute Coronary Events risk score variables and optimal in-hospital or
discharge medical therapy. Optimal in-hospital and discharge medical care were delivered in 40% and 46% of admissions,
respectively. Wide variability in both in-hospital and discharge medical care was present, with few hospitals reaching
consistently high (>90%) levels. Patients receiving optimal in-hospital medical therapy had an adjusted odds ratio (95%
confidence interval)=0.93 (0.71, 1.22) for in-hospital death and an adjusted odds ratio (95% confidence interval)=0.79
(0.63, 0.99) for major adverse cardiovascular event rates. Patients who received optimal in-hospital medical care were
far more likely to receive optimal discharge care (adjusted odds ratio [95% confidence interval] = 10.48 [9.37, 11.72]).
Conclusions—Strategies to improve in-hospital and discharge medical therapy are needed to improve local process-of-care
measures and ACS outcomes in Kerala. (Circ Cardiovasc Qual Outcomes. 2013;06:436-443.) |
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| Descrición Física: | July 2013 |