Abstract 2857: Improved Treatment and Reduced Mortality in Patients with Acute Coronary Syndrome using a Guideline-based Critical Pathway
Introduction: In this study, we hypothesized that an American College of Cardiology/American Heart Association (ACC/AHA) Guideline based critical care pathway Acute Coronary Syndrome Emergency Treatment Strategies (ACSETS) reduces mortality in patients with acute coronary syndrome (ACS).
Methods: This real world, observational study was conducted in a Western New York hospital system. The historical control group consisted of patients admitted to the Emergency Department (ED) with Unstable Angina (UA) or Myocardial Infarction (MI), as identified through discharge ICD-9 codes, from 01/01/02–10/15/02. The ACSETS (intervention) group consisted of patients discharged between 05/01/03–08/31/04 who used ED, inpatient, and/or discharge order forms along with educational programs and feedback. Data were collected via chart review. Cohorts were compared to assess the impact of ACSETS on 1-year mortality. Group comparison was evaluated using adjusted Cox proportional hazards modeling with hazard ratio (HR) and 95% confidence interval (CI) assessment. All models were adjusted for variables with significant univariate group differences.
Results: The study was comprised of 1,709 ACSETS and 1,240 historical control patients. Mean age was significantly lower among ACSETS patients while gender, race, and comorbidity distributions were similar with the exception of CHF and dyslipidemia. Significantly more ACSETS patients received ACE inhibitor, ARB, beta-blocker, statin or other dyslipidemia medication in first 24 hours and at discharge (p<0.05). In all patients and among MI patients, there ACSETS patients had a lower risk of mortality (HR: 0.83 & 0.79, respectively). Mortality rates were similar between control group and ACSETS UA patients.
Conclusions: In conclusion, initiation of an ACC/AHA ACS guideline-based critical pathway reduced 1-year mortality in ACS patients. Patients with MI seemed to particularly benefit from intervention.