Abstract 8397: Action Registry Guideline Adherences Differ Between ST-Elevation and Non-ST Elevation Myocardial Infarction Patients

Abstract

Background: Based on the ACC/AHA 2008 Performance Measures for Adults with Acute Myocardial Infarction, the ACTION Registry-GWTG (Get with the Guidelines) Outcomes Report examines a given site's performance on acute and discharge guideline metrics used in treating heart attacks. We reviewed our data from the Outcomes Report to compare guideline adherences between ST Elevation myocardial infarction (STEMI) and non-ST Elevation myocardial infarction (NSTEMI) patients. Methods: There were 76,493 STEMI and 117,440 NSTEMI ACTION Registry participants between the 4 th quarter of 2007 through the 3 rd quarter of 2010 (i.e., 2008-2010). Acute guideline metrics included aspirin (ASA) on arrival and evaluation of left ventricular systolic function (LVSF). Discharge guideline metrics included aspirin (ASA), beta-blocker (BB), angiotensin-converting enzyme inhibitor (ACE) or angiotensin-receptor blocker (ARB) if ejection fraction <40%, statin, adult smoking cessation advice (ASCA), and cardiac rehabilitation referral (CRR). We analyzed adherences to guidelines in STEMI and NSTEMI patients over three years - nationally (NAT), at our center (MMH), and at the nation's top 10% centers (TOP). Chi square and Fischer's exact test were used to compare the two groups. Results: Conclusions: We found statistically significant discrepancies in metric guideline adherences between STEMI and NSTEMI patients over three years. Adherences were higher in the STEMI compared with NSTEMI groups in nearly all metrics measured. This may reflect the presence of timely and comprehensive “Code STEMI” guidelines in place. Perhaps “Code NSTEMI” guidelines or diagnosis-based (eg, NSTEMI-based) medication reconciliation forms could further improve NSTEMI guideline adherences.