Adherence to Cardiac Practice Guidelines in the Management of Non-ST-Elevation Acute Coronary Syndromes:A Systematic Literature Review
| Autor: | Ineke van der Wulp, Martine C. de Bruijne, J. Engel, Cordula Wagner, Nikki L. Damen |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Acute coronary syndrome MEDLINE CINAHL 030204 cardiovascular system & hematology Cochrane Library Coronary Angiography Article Angina 03 medical and health sciences 0302 clinical medicine systematic review medicine Humans Angina Unstable unstable angina [MeSH] 030212 general & internal medicine Acute Coronary Syndrome Intensive care medicine business.industry Unstable angina ST elevation General Medicine medicine.disease Systematic review Acute coronary syndrome [MeSH] Practice Guidelines as Topic Physical therapy Guideline Adherence guideline adherence [MeSH] Cardiology and Cardiovascular Medicine business |
| Zdroj: | Engel, J, Damen, N L, van der Wulp, I, de Bruijne, M C & Wagner, C 2017, ' Adherence to Cardiac Practice Guidelines in the Management of Non-ST-Elevation Acute Coronary Syndromes : A Systematic Literature Review ', Current cardiology reviews, vol. 13, no. 1, pp. 3-27 . https://doi.org/10.2174/1573403X12666160504100025 Current Cardiology Reviews |
| DOI: | 10.2174/1573403X12666160504100025 |
| Popis: | BACKGROUND: In the management of non-ST-elevation acute coronary syndrome (NSTACS) a gap between guideline-recommended care and actual practice has been reported. A systematic overview of the actual extent of this gap, its potential impact on patient-outcomes, and influential factors is lacking.OBJECTIVE: To examine the extent of guideline adherence, to study associations with the occurrence of adverse cardiac events, and to identify factors associated with guideline adherence.METHOD: Systematic literature review, for which PUBMED, EMBASE, CINAHL, and the Cochrane library were searched until March 2016. Further, a manual search was performed using reference lists of included studies. Two reviewers independently performed quality-assessment and data extraction of the eligible studies.RESULTS: Adherence rates varied widely within and between 45 eligible studies, ranging from less than 5.0 % to more than 95.0 % for recommendations on acute and discharge pharmacological treatment, 34.3 % - 93.0 % for risk stratification, and 16.0 % - 95.8 % for performing coronary angiography. Seven studies indicated that higher adherence rates were associated with lower mortality. Several patient-related (e.g. age, gender, co-morbidities) and organization-related (e.g. teaching hospital) factors influencing adherence were identified.CONCLUSION: This review showed wide variation in guideline adherence, with a substantial proportion of NST-ACS patients possibly not receiving guideline-recommended care. Consequently, lower adherence might be associated with a higher risk for poor prognosis. Future research should further investigate the complex nature of guideline adherence in NST-ACS, its impact on clinical care, and factors influencing adherence. This knowledge is essential to optimize clinical management of NSTACS patients and could guide future quality improvement initiatives. |
| Databáze: | OpenAIRE |
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