管理crusade研究对不稳定性心绞痛患者进行快速危险分层可以减轻早期实施accaha指南的不良结果吗ppt课件

CRUSADE： Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines? 对不稳定性心绞痛患者进行快速 危险分层可以减轻早期实施 ACC/AHA指南的不良结果吗 Goals for CRUSADE Improve Adherence to ACC/AHA Guidelines Improve Patient Outcomes nAspirin lClopidogrel nBeta Blocker nHeparin (UFH or LMWH) nGP IIb-IIIa Inhibitor lCath/PCI nAspirin nClopidogrel nBeta Blocker nACE Inhibitor nStatin/Lipid Lowering nSmoking Cessation nCardiac Rehabilitation Acute TherapyAcute Therapy Discharge TherapyDischarge Therapy 2002 ACC/AHA Guidelines Update Sites Who Have Submitted = 486 AK (0) WA (8) OR (5) CA (36) ID (0) NV (3) MT (0) WY (0) CO (8) NM (2) ND (1) SD (2) NE (4) KS (3) OK (8) TX (17) MN (4) IA (4) MO (12) AR (4) LA (8) WI (5) MI (24) MI UT (1) AZ (9) HI (1) IL (15) IN (9) KY (8) TN (15) MS (7) AL (11) GA (15) FL (33) SC (6) NC (13) VA (16) OH (30) WV (3) PA (39) NY (36) MD (13) ME (1) VT (1) NH (2) NJ (10) MA (11) CT (8) DE (3) RI (1) DC (1) CRUSADE Site DistributionCRUSADE Site Distribution CRUSADE DATA SUBMISSION From 486 Sites 130,735! Representation of Elderly Community vs. RCT Population % Age 75 Decade GRACE VIGOUR RCTs CRUSADE Lee, JAMA, 2001Lee, JAMA, 2001 Gender and Age: NSTE ACS Patient Age % of population Age and Comorbid Illness % of population Creatinine Clearance and Age VIGOUR Trials and CRUSADE Patient Age (Yrs) Median Creatinine Clearance* Acute Medication Use Q3 2004 (Within 1st 24 hours in patients without contraindications) 96%96% 91%91%88%88% 46%46% 0% 20% 40% 60% 80% 100% ASAASA BetaBeta BlockersBlockers HeparinHeparin (LMW + UFH)(LMW + UFH) GP GP IIb-IIIaIIb-IIIa InhibitorsInhibitors Q4 2004 CRUSADE data ClopidogrelClopidogrel 55%55% Trends in Acute Therapy Adherence (Among Patients Without Contraindications) Quarter 1, 2002 through Quarter 4, 2004 82%82% 61%61% 0% 15% 30% 45% 60% 75% CathCathCathCath 48 hr 48 hrPCIPCICABGCABGPCI 48 hrPCI 48 hr Invasive Cardiac Procedures Q4 2004 (Among Patients Without Contraindications to Cath) 55%55% 52%52% 40%40% 0% 15% 30% 45% 60% 75% CathCathCathCath 48 hr 48 hrPCIPCICABGCABG 12%12% PCI 48 hrPCI 48 hr 90% Q4 2004 CRUSADE Data Trends in Invasive Procedure Use (Among Patients Without Contraindications to Cath) Quarter 1, 2002 through Quarter 4, 2004 The Train Speeds Up. Faster Cardiac Catheterization* * Among those receiving cath The Train Speeds Up. Shrinking In-hospital ACS Care 3 Days 35% vs 47% Discharge Medication Use Q4 2004 (In patients without contraindications) *LVEF 40%, CHF, DM, HTN # Known hyperlipidemia, TC, LDL 94%94% 91%91% 0%0% 20%20% 40%40% 60%60% 80%80% 100%100% ASABeta Blockers ACE- or ARB* 69%69% Any Lipid- Lowering Agent# 88%88% 72%72% Clopidogrel Trends in Discharge Therapy (Among Patients Without Contraindications) Quarter 1, 2002 through Quarter 4, 2004 Overall Adherence Trends Over Time Quarter 1, 2002 Quarter 3, 2004 Quarter 1, 2002 through Quarter 4, 2004 Need Right Drug but Also Right Dose Excessive Antithrombotic Dosing by Age Q1-Q2 2004 CRUSADE data: Consequences of Excessive Dosing: RBC Transfusions by Dose Excess RBC Transfusion (%) Does it Matter? Mortality Rates by # of Acute Guideline Recommended Therapies Received % In-hospital Mortality Number of Recommended Therapies * Therapies = Acute Aspirin, Acute Beta-blockers, Acute Heparin, GP IIb/IIIa inhibitors, Cardiac Catheterization 48 hours Adjusted OR: 0.72 (0.68,0.76) Mortality Rates by # of Acute Guideline Recommended Therapies Received by Age Group Age Group % In-hospital Mortality Number of Recommended Therapies * Therapies = Acute Aspirin, Acute Beta-blockers, Acute Heparin, GP IIb/IIIa inhibitors, Cardiac Catheterization 48 hours 0.71 (0.67,0.75)0.79 (0.75,0.83) Adj. OR* Mortality Rates by # of Acute Guideline Recommended Therapies Received by Risk Group Risk Group % In-hospital Mortality Number of Recommended Therapies * Therapies = Acute Aspirin, Acute Beta-blockers, Acute Heparin, GP IIb/IIIa inhibitors, Cardiac Catheterization 48 hours; Based on CRUSADE Risk Score Latest Results in NSTE ACS in US Conclusions q Crusade continues to represent real world NST ACS qOlder patients qMore comorbidity qCare for NSTE ACS is improving: qContinued progress in adherence to ACC/AHA Guidelines for both acute and discharge treatments qMore e