Emerging practice patterns in the management of stemi and high risk ACS-early findings from the CONCORDANCE registry.

Background: Registry data reporting time-based changes in the management of acute coronary syndromes (ACS) is limited in the Australian context. This analysis of the Australian Cooperative National Registry of Acute Coronary care, Guideline Adherence and Clinical Events (CONCORDANCE) reports emerging practice patterns in the delivery of care for high risk ACS. Method(s): CONCORDANCE is a prospective observational registry enrolling patients from 16 Australian centres reporting on pre identified key primary indicators (KPI's). Patient's with ST elevation myocardial infarction (STEM), non ST elevation myocardial infarction (NSTEMI) and unstable angina considered high risk for an ACS event are eligible for inclusion. This analysis reports KPI process measures and adherence of evidence based therapies for these patients. Current results: 901 patients are currently enrolled. Of these, 316 (35%) were admitted for STEMI and 81 (25.6%) patients received thrombolysis. Thirty-five (43%) of these patients received thrombolysis within 30 minutes. 131 (41.4%) patients underwent primary PCI and 212 (67%) patients received either thrombolysis or primary PCI. Rates of use for evidence based medical therapies (excluding contra-indicated medications) included aspirin (89.5%), statins (93%), beta-blockers (82%), clopidogrel (75%), ACE (64%) and ARB (16.3%). Conclusion(s): Detailed reporting of KPI's in this observational registry provides opportunities to measure adherence to evidence based therapy, identifies disparities in key process measures and presents opportunities for intervention at centres operating below the benchmark.