Clinical InvestigationAcute Ischemic Heart DiseaseChanges in glycoprotein IIb/IIIa inhibitor excess dosing with site-specific safety feedback in the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) initiative
Section snippets
CRUSADE QI initiative
The CRUSADE QI initiative collected data on patients with high-risk NSTE ACS admitted to participating US hospitals from November 2001 to January 2007.10, 11 Patient eligibility required ischemic symptoms lasting ≥10 minutes combined with positive cardiac markers (troponin or creatine kinase–MB) or ischemic ST-segment electrocardiographic (ECG) changes (ST-segment depression or transient ST-segment elevation) within 24 hours of hospital admission. CRUSADE hospitals participated voluntarily and
Glycoprotein IIb/IIIa inhibitor use
Of the 25,641 patients without contraindication to GP IIb/IIIa inhibitors (eligible), 13,569 received GP IIb/IIIa inhibitors and 12,072 did not. Between Q4 2005 and Q4 2006, declines in use of GP IIb/IIIa inhibitors were not statistically significant overall (53.2%-51.2%, Ptrend = .05). However, use of GP IIb/IIIa inhibitors did decline among the elderly (37.7%-33.6%, Ptrend = .03).
During index hospitalization, 43.8% of GP IIb/IIIa inhibitor–eligible patients underwent PCI only, 8.4% underwent
Discussion
Traditionally, QI initiatives have worked to improve patient outcomes by increasing the use of effective therapies.18, 19, 20, 21, 22 To our knowledge, this is the first QI initiative of this size focused on optimizing the proper dosing of effective therapies through systematic feedback. Within only 9 months of the initiation of safety feedback, we observed a 20.0% relative decline (12.8% absolute decline) in the excess dosing rate of GP IIb/IIIa inhibitors among the elderly, with
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Cited by (12)
Temporal trends in and factors associated with bleeding complications among patients undergoing percutaneous coronary intervention: A report from the national cardiovascular data CathPCI registry
2012, Journal of the American College of CardiologyCitation Excerpt :Additionally, because our analysis included a later time period, we were able to capture greater use of direct thrombin inhibitors; as shown in the present analysis, greater use of bivalirudin might explain some of the reduction in annual bleeding events. Other potential explanations of the reduction in annual bleeding events include improvements in reducing excess dosing during the study (24) and greater attention to femoral access (25). In our analysis, the largest relative reduction in annual bleeding risks was noted to be in the elective PCI subgroup.
Prospective observational studies to assess comparative effectiveness: The ISPOR good research practices task force report
2012, Value in HealthCitation Excerpt :This caution in allowing broad access to data reflects scientific, ethical concerns about data ownership, patient privacy, and contractual obligations to sponsors, physicians, and hospitals, who have agreed to share their patients' data in a proscribed, limited manner. However, a number of observational clinical registries have developed written publication guidelines for data access and approval of publication topics and authorship, which at least clarify how interested parties may approach investigators for collaborative research, if not providing direct access to the data of interest (e.g., The Global Registry of Acute Coronary Events [54], Coronary Artery Risk Development in Young Adults [55], The Global Longitudinal Study of Osteoporosis in Women [56], and Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines [57].) A number of limited data sets have been shared with bona fide investigators from outside the scientific advisory boards of these studies [58].
Platelet biology and response to antiplatelet therapy in women: Implications for the development and use of antiplatelet pharmacotherapies for cardiovascular disease
2012, Journal of the American College of CardiologyCitation Excerpt :The cumulative evidence highlights a conundrum in which women are at higher risk of both thrombosis and bleeding compared with men (60). Excess antithrombotic drug dosing, an important culprit, can be reduced by implementation of quality-improvement measures (71), but sex differences in bleeding risk persist even with appropriate dosing. These differences might be explained by innate differences in platelet reactivity and contributing influences from inflammatory and hormonal processes, as outlined earlier.
Safety and efficacy of adjusted-dose eptifibatide in patients with acute coronary syndromes and reduced renal function
2011, American Heart JournalCitation Excerpt :Despite being under the more strict directives (regulations) of a randomized clinical trial, it is likely that in this case, as in clinical practice, clinical judgment on the need for dose adjustment is often based on the serum creatinine value, and more accurate and appropriate CrCl assessment is not always performed. Similarly, the failure to reduce incorrect dosing of eptifibatide through education and feedback alone has been demonstrated in clinical practice by the CRUSADE investigators.26 The availability of automatic CrCl estimation on laboratory reports, combined with the use of dosing guides on standard order forms or computerized order entry systems, may represent valid tools to guide the selection of the appropriate dose, thereby eliminating dosing errors.27
Trends in use of anti-thrombotic agents and outcomes in patients with non-ST-segment elevation myocardial infarction (NSTEMI) managed with an invasive strategy
2016, Indian Heart JournalCitation Excerpt :Furthermore, there was a significant decline in major bleeding complications during index hospitalization. Our study confirms the changing trends in use of antithrombotic agents, reductions in excess dosing, and bleeding events in recent years among NSTEMI patients.18 Our data reflects 4 recent years of ATA usage in the management of NSTEMI patients treated invasively, and represents important changing trends in cardiology practice.
- c
For the CRUSADE Investigators.