Quality of care of patients hospitalized with acute coronary syndromes

Intern Med J. 2002 Nov;32(11):502-11. doi: 10.1046/j.1445-5994.2002.00267.x.


Background: Measurement and improvement of quality of care is a priority issue in health care. Patients hospitalized with acute coronary syndromes (ACS) constitute a high-risk population whose care, if shown to be suboptimal on the basis of available research evidence, may benefit from quality improvement interventions.

Aim: To evaluate the quality of in-hospital care for patients with ACS, using explicit quality indicators.

Methods: Retrospective case note review was undertaken of 397 patients admitted to three teaching hospitals in Brisbane, Queensland, Australia, between 1 October 2000 and 17 April 2001. The main outcome measures were 12 process-of-care quality indicators, calculated as either: (i) the proportion of all patients who received specific interventions or (ii) the proportion of ideal patients who received specific interventions (i.e. patients with clear indications and lacking contraindications).

Results: Quality indicators with values above 80% included: (i) patient selection for thrombolysis (100%) and discharge prescription of beta-blockers (84%), (ii) antiplatelet agents (94%) and (iii) lipid-lowering agents (82%). Indicators with values between 50% and 80% included: (i) timely performance of electrocardiogram (ECG) on admission (61%), (ii) early coronary angiography (75%), (iii) measurement of serum lipids (71%) and (iv) discharge prescription of angiotensin-converting-enzyme (ACE) inhibitors (73%). Indicators with values <50% included: (i) timely administration of thrombolysis (35%), (ii) non-invasive risk assessment (23%) and (ii) formal in-hospital, and post-hospital cardiac rehabilitation (47% and 7%, respectively).

Conclusion: There were delays in performing ECG and administering thrombolysis to patients who presented to emergency departments with ACS. Improvement is warranted in use of non-invasive procedures for identifying high-risk patients who may benefit from coronary revascularization as well as use of serum lipid measurements, ACE inhibitors and cardiac rehabilitation.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angina, Unstable / drug therapy
  • Angina, Unstable / therapy*
  • Cardiology Service, Hospital / standards*
  • Female
  • Hospitalization
  • Hospitals, Teaching / standards
  • Humans
  • Male
  • Medical Audit
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / therapy*
  • Practice Guidelines as Topic
  • Quality Indicators, Health Care
  • Quality of Health Care*
  • Queensland
  • Syndrome
  • Thrombolytic Therapy