COMPLIANCE WITH CLINICAL PRACTICE GUIDELINES FOR NON ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROME: ASSOCIATION BETWEEN OUTCOMES AND PREDICTORS OF POOR MANAGEMENT (RECORD-3 REGISTRY DATA)

The registries of acute coronary syndrome (ACS) are significant tools of obtaining objective data on triage and management of patients in clinical practice.

Purpose. To assess the compliance with clinical practice guidelines and its association with clinical outcomes in patients with non ST-segment elevation acute coronary syndrome (NSTE-ACS) in Russian hospitals, participating in the ACS registry RECORD-3.

Materials and methods. The analysis was conducted based on the data of the Russian ACS Registry RECORD-3, which included 47 hospitals from 37 Russian cities. 2370 consecutive patients with ACS admitted to participating hospitals in the period from March to April, 2015 were enrolled in the registry. Out of those, 1502 (63.4 %) patients were present with NSTE-ACS. The compliance with clinical guidelines was assessed using the following criteria: the implementation of the class I-A or I-B recommendations from 2015 European Society of Cardiology guidelines. The number of recommendations used by physicians (from 8 to 15) was calculated for each patient. The number of implemented recommendations was calculated and presented as percentage.

Results. 100 % implementation rate of the class I-A or I-B recommendations was determined in 1.4 % of patients. Over 75 % of the recommendations were implemented in 19% of patients, and less than 50 % – in 14.6 % of patients. The median implementation rate of clinical guidelines was 63.6 % (the first-third quartiles of 54.5–72.7 %). The proportion of patients with the first and the second quartiles of implemented clinical practice guidelines (poor management) was 54.0 %. The proportion of patients with the third and the fourth quartiles (good management) was 46.0 %. The mortality rate in the group of patients with good physician compliance with clinical practice guidelines was 1.0 %, whereas in patients with poor physician compliance, it was 3.7 % (p=0.0015). The independent predictors of poor physician compliance with clinical practice guidelines were identified and included Killip class IV congestive heart failure, admission to a “non-invasive” hospital, as well as self/family referrals to the hospital, positive history of atrial fibrillation, the absence of ST-segment depression and elevated troponin levels, non-use of acetylsalicylic acid and angiotensin-converting enzyme / sartana, initial blood glucose levels ≤6 mmol / l.

Conclusion. 75 % of clinical guidelines for the management of patients with NSTE-ACS were implemented by physicians only in 19 % of patients; the in-hospital mortality in patients assigned to poor physician management was significantly higher than in patients with good management (3.7 % vs. 1.0 %, p=0.0015); the independent predictors of poor physician management were determined, allowing defining a group of ACS patients, who require active and complete implementation of clinical practice guidelines by physicians

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