THE PROVINCIAL GUIDELINES EFFECT ON RISK-BASED ACCESS TO CARDIAC CATHETERIZATION IN PATIENTS WITH NON-ST ELEVATION ACUTE CORONARY SYNDROMES IN NOVA SCOTIA (2003 – 2013)

Abstract

Background: For patients with Non-ST Elevation Acute Coronary Syndrome (NSTEACS), observational studies have found cardiac catheterization being utilized more in patients at lower risk compared to their higher risk counterparts, contrary to the recommendations of clinical practice guidelines. This study seeks to evaluate to what extent catheterization practices in Nova Scotia align with the provincial guideline recommendations for ACS. Methods: We conducted a retrospective cohort study between 2003 and 2013. The primary outcome was utilization and timing of catheterization. The secondary outcome was one-year mortality. Multivariable logistic regression models were fit to estimate predictors of catheterization and mortality. Results: While catheterization rates increased, higher risk patients were less likely to receive the procedure. One-year mortality was lower for those receiving catheterization, especially for patients at intermediate to high risk. Conclusions: Targeting catheterization to higher risk patients would be more consistent with recommendations, and has potential to result in improved outcomes.