Clopidogrel use and hospital quality in medically managed patients with non-ST-segment-elevation myocardial infarction

Circulation. Cardiovascular Quality and Outcomes
Thomas M MaddoxJohn S Rumsfeld

Abstract

Clopidogrel prescription is a class I guideline recommendation for medically managed patients with non-ST-segment-elevation myocardial infarction (NSTEMI). However, clopidogrel has historically been underused in this population. We evaluated contemporary rates of its use and evaluated associated factors, with a particular focus on hospital quality of myocardial infarction (MI) care. We examined clopidogrel prescription rates among 23 186 patients with NSTEMI discharged from 382 US hospitals between October 2009 and March 2011. Associations between clopidogrel prescription and various patient and hospital factors, including hospital quality of MI care, were determined with regression modeling. Of the sample, 54.9% of eligible patients with NSTEMI received clopidogrel prescription at hospital discharge. Variation in rate by hospital was large, ranging from 22% to 97%. A variety of patient and hospital factors were associated with clopidogrel prescription. Hospital quality of MI care demonstrated modest association with clopidogrel prescription (odds ratio, 0.68; 95% CI, 0.54-0.85) between the lowest and highest hospital quality quartile) and accounted for 5.7% of the variation in prescription rates. Clopidogrel prescription is si...Continue Reading

References

Aug 25, 2001·The New England Journal of Medicine·S YusufUNKNOWN Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators
Apr 12, 2006·Archives of Internal Medicine·Pierluigi TricociRobert A Harrington
May 30, 2007·Health Affairs·Charles N KahnSusan Van Gelder
Nov 6, 2007·The New England Journal of Medicine·Stephen D WiviottUNKNOWN TRITON-TIMI 38 Investigators
Feb 26, 2008·American Heart Journal·Mark Y ChanMatthew T Roe
Sep 1, 2009·The New England Journal of Medicine·Lars WallentinMona Thorsén

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