دانلود مقاله : Predictors of Adherence to Performance Measures in Patients with Acute Myocardial I

چکیده : 

BACKGROUND: There have been substantial improvements in the use of evidence-based, guideline-recommended

therapies for patients with acute myocardial infarction. Nevertheless, some gaps, disparities, and variations in use

remain. To understand how such gaps in recommended care may be narrowed further, it may be useful to determine

those factors associated with lessened adherence to guideline-based care.

METHODS: The Get with the Guidelines-Coronary Artery Disease registry measured adherence with 6 performance

measures (aspirin within 24 hours, discharge on aspirin and beta-blockers, patients with low ejection fraction

discharged on angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, smoking cessation counseling,

use of lipid-lowering medications) in 148,654 patients with acute myocardial infarction between 2002 and 2009.

Logistic multivariable regression models using generalized estimating equations were utilized to identify patient and

hospital characteristics associated with adherence to each of 6 measures, and to a summary score of performance for

all measures, in eligible patients.

RESULTS: We identified 10 variables that were associated significantly with either greater adherence

(hypertension, hyperlipidemia, hospital with full interventional capabilities, calendar year) or worse

adherence (age, female sex, congestive heart failure, chronic renal insufficiency, atrial fibrillation, chronic

dialysis) in at least 4 of the 6 treatment adherence models, as well as the summary score adherence model.

Age, sex, and calendar year were significant in all models.

CONCLUSIONS: Use of evidence-based acute myocardial infarction treatments remains less than ideal for

certain high-risk populations. The close correlations among factors associated with underperformance

highlights the potential for specifically targeting and tailoring quality improvement interventions