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Aggressive heart therapies still underused, despite blood chemical status

rs consulted the nationwide quality improvement initiative named CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC and American Heart Association Guidelines). The registry collects data on outcomes and usage of proven drugs like aspirin, beta-blockers, heparin and anti-platelet drugs such as glycoprotein (GP) IIb/IIIa inhibitors, as well as the use of catheterization and angioplasty procedures.

CRUSADE focuses on heart patients with unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI). These patients typically arrive at emergency rooms with chest pain, but often will not have telltale signs of a heart attack on the initial electrocardiogram. They might only be diagnosed with a heart attack when the results of the blood tests are reported a few hours later.

While patients with acute STEMI are at higher risk of dying within 30 days of their hospital stay, patients with UA/NSTEMI actually have a higher risk of dying six months and one year after initial hospital presentation. It is estimated that about 1.3 million Americans are hospitalized each year with UA/NSTEMI

CRUSADE continuously gathers data from more than 400 participating U.S. hospitals on treatments for patients with UA/NSTEMI and provides regular feedback to hospitals with the ultimate goal of improving adherence to the ACC/AHA treatment guidelines and patient outcomes.

The researchers identified 29,357 CRUSADE patients who had both levels of biochemicals taken within the first 36 hours of admission.

As would be expected, patients who had negative CK-MB and troponin levels (11.9 percent of the sample) had the lowest usage of the different therapies, and they had the lowest death rate -- 2.71 percent. At the other extreme, patients who were positive for both biomarkers (59.7 percent) had the highest usage of the therapies, as well as the highest death rate, 5.87 p
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Contact: Richard Merritt
merri006@mc.duke.edu
919-684-4148
Duke University Medical Center
10-Mar-2004


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