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    Diffusion of troponin testing in unstable angina patients: adoption prior to guideline release

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    Authors
    Centor, Robert M.
    Allison, Jeroan J.
    Weissman, Norman W.
    Canto, John
    Heudebert, Gustavo R.
    Juarez, Lucia
    Kiefe, Catarina I.
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2003-12-19
    Keywords
    Aged
    Angina, Unstable
    Angioplasty, Transluminal, Percutaneous Coronary
    Angiotensin-Converting Enzyme Inhibitors
    Biological Markers
    Female
    Guideline Adherence
    Heart Catheterization
    Humans
    Logistic Models
    Male
    *Patient Selection
    Time Factors
    Troponin
    Bioinformatics
    Biostatistics
    Epidemiology
    Health Services Research
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    Link to Full Text
    http://dx.doi.org/10.1016/S0895-4356(03)00200-2
    Abstract
    BACKGROUND: We examined diffusion of troponin testing in Medicare patients with unstable angina before the release of year 2000 American College of Cardiology/American Heart Association guidelines recommending measurement in all patients with acute coronary syndromes. METHODS: We identified unstable angina admissions from Medicare administrative files for 22 Alabama hospitals over two time periods: 03/1997-02/1998 and 01/99-12/1999. Data were obtained from chart abstraction. Patients not confirmed for unstable angina by a clinical algorithm were eliminated. RESULTS: For 1997-1998, 1116 (87.7%) of all identified cases were clinically confirmed for unstable angina, and 1176 (90.3%) were confirmed for 1999. In 1997-1998, 235 (21%) of unstable angina patients had troponin measured, compared to 822 (70%) in 1999. From 1999, patients with troponin measurement, vs. those without, more likely had typical angina (50.9%, 37.4%), chest pain on arrival (72.8%, 57.1%), and chest pain at rest (45.4%, 37.2%) and more often received EKG within 20 min of presentation (46.3%, 27.9%) (P<.0005 for all). Patients with abnormal troponin levels more often received angiotensin converting enzyme inhibitors (54.6%, 18.3%), cardiac catheterization (45.4%, 31.2%), and percutaneous coronary intervention (18.6%, 4.8%) (P<.05 for all). These associations remained significant after multivariable adjustment for patient and hospital characteristics. CONCLUSIONS: This study demonstrates increasing and appropriate use of troponin before guideline release. Our findings suggest that guidelines may codify currently accepted practice rather than always disseminate new knowledge. The same forces that lead to guideline development and release may also lead to changes in clinical practice before guideline release.
    Source
    J Clin Epidemiol. 2003 Dec;56(12):1236-43.
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/47684
    PubMed ID
    14680675
    Related Resources
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    Population and Quantitative Health Sciences Publications

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