Quality of care of patients presenting with acute coronary syndrome in emergency departments in Taiwan

Abstract

Acute coronary syndrome (ACS) represents one of the most common causes of acute medical admission at Taiwan hospitals. Clinical practice guidelines have been developed to provide physicians with evidence-based approaches to the patient’s daily care. However, data have suggested the presence of a large widespread gap between the medical care provided and the evidence-based recommendations. This report should help us to understand the management of ACS in emergency departments based on quality of care indicators and adherence to recommended practice behaviors and international guidelines in Taiwan. A retrospective patient chart review was undertaken in 14 participating hospitals from July 1, 2006 to June 30, 2007. A random sample of 2388 patients treated at the emergency rooms of these hospitals with the discharge code of ACS was identified. The data captured included final diagnosis, the acute therapies used, the in-hospital revascularization procedures used and the time to initiation of the various procedures. Among the 2388 patients sampled, the mean age was 66.4 years old of which 67.9% were male. Overall, 42.0% of the patients had a history of coronary artery disease (CAD) including 17.0% with a prior myocardial infarction, 23.0% with a prior percutaneous coronary intervention, and 5.5% who had had a prior coronary artery bypass graft. Final diagnoses reported consisted of 29% (n = 701) with ST segment elevation myocardial infarction (STEMI), 30% (n = 718) with unstable angina, 24% (n = 578) with nonSTEMI, 14% (n = 335) with CAD/stable angina and 2.3% (n = 56) with another diagnosis. Out of all STEMI patients, 77.5% (n = 543) received early catheterization and only 4.7% (33/701) were given thrombolytic agent treatment. In addition, among STEMI patients who received an early interventional strategy, only 41.7% received urgent cardiac catheterization within 90 minutes. The average time until a 12-lead electrocardiogram was obtained was 20.6 minutes, and only 52% of the patients had the electrocardiogram completed within 10.0 minutes. Only 42% of patients who underwent an interventional strategy had catheterization intervention within 90 minutes after arriving at the emergency room. There were significant variations in practice between hospital types and across geographic areas. Further stricter implementation of the guidelines is needed to improve the quality of care provided to Taiwanese ACS patients.