Charles Darwin University

CDU eSpace
Institutional Repository

 
CDU Staff and Student only
 

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)

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 and Brieger, David B. (2015). 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). American Heart Journal,170(3):566-572.

Document type: Journal Article
Citation counts:
Google Scholar Search Google Scholar

IRMA ID 75039815xPUB932
Title 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)
Author 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.
Journal Name American Heart Journal
Publication Date 2015
Volume Number 170
Issue Number 3
ISSN 0002-8703   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84941741564
Start Page 566
End Page 572
Total Pages 7
Place of Publication United States
Publisher Mosby, Inc.
Field of Research 1103 - Clinical Sciences
HERDC Category C1 - Journal Article (DIISR)
Abstract 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.

DOI http://dx.doi.org/10.1016/j.ahj.2015.06.025   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
Versions
Version Filter Type
Access Statistics: 5 Abstract Views  -  Detailed Statistics
Created: Tue, 26 Jul 2016, 12:52:00 CST