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Regional Differences in Quality of Care and Outcomes for the Treatment of Acute Coronary Syndromes: An Analysis From the Get With the Guidelines Coronary Artery Disease Program

Laskey, Warren MD*; Spence, Nathan MD*; Zhao, Xin BA; Mayo, Rebecca RN, PhD, MA, CNP*; Taylor, Robert MD*; Cannon, Christopher P. MD; Hernandez, Adrian F. MD§; Peterson, Eric D. MD, MPH†§; Fonarow, Gregg C. MD

Critical Pathways in Cardiology: March 2010 - Volume 9 - Issue 1 - p 1-7
doi: 10.1097/HPC.0b013e3181cdb5a5
Original Article

Background: Geographic differences in the delivery of guideline-driven care following acute myocardial infarction have been described. The effect of hospital participation in a national performance improvement program on regional variation in quality of care and in-hospital outcomes for acute coronary syndromes (ACS) is unknown.

Methods: We evaluated the variation in conformity to the American Heart Association Get With The Guidelines–Coronary Artery Disease Program quality measures across 4 geographic regions (Northeast, Midwest, South, and East) in 161,236 patients admitted for ACS to 436 Get With The Guidelines hospitals. We evaluated 6 measures (aspirin within 24 hours, aspirin at discharge, ACEI or ARB therapy for left ventricular systolic dysfunction, beta-blocker at discharge, lipid-lowering medication for qualified patients, smoking cessation advice); a binary “all-or-none” process performance measure (primary outcome); an “opportunity-based” overall composite score (secondary outcome); in-hospital length of stay, and in-hospital mortality. Multivariable logistic regression was performed to test the associations between performance measures and short-term outcomes and geographic region.

Results: Data were collected from January 2, 2000 to January 2, 2008. There was no significant regional variation in either the “all-or-none” (Northeast: 79.3%; Midwest: 83.2%; South: 78.9%; West: 81.6%) or “opportunity-based” (Northeast: 91.9%; Midwest: 93.6%; South: 91.5%; West: 92.6%) composite performance measures. Both performance measures exhibited significant improvement with participation time irrespective of region. In-hospital mortality was similar among regions. Adjusted hospital length of stay was significantly shorter in the Midwest.

Conclusion: Quality improvement program participation may help to facilitate high quality, consistent care for patients with ACS.

From the *Division of Cardiology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM; †Duke Clinical Research Institute, Durham, NC; ‡Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; §Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC; and ¶Division of Cardiology, Department of Medicine, Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, CA.

The Get With The Guidelines Project is supported by the American Heart Association in part through an unrestricted education grant from Merck-Schering Plough Partnership who did not participate in the design, analysis, or manuscript preparation.

Reprints: Warren Laskey, MD, Division of Cardiology, Department of Internal Medicine, MSC10–5550, 1 University of New Mexico, Albuquerque, NM 87131. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.