Abstract 90: Contemporary Use of Renin-Angiotensin System Blockers in Acute Coronary Syndromes: Findings from Get With The Guidelines-Coronary Artery Disease Program
Bibliographic record
Abstract
Background: Angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) initiated after myocardial infarction (MI) reduce mortality and are American College of Cardiology / American Heart Association (ACC/AHA) guideline recommended. Yet, contemporary use of ACEI or ARB in acute coronary syndrome (ACS) patients at hospital discharge has not been well studied. Objective: To examine ACEI/ARB prescription based on current Class I guideline criteria, patient and hospital factors associated with use, and temporal trends in patients hospitalized with ACS. Methods: We performed an observational analysis of 80,241 patients admitted with an ACS and discharged home from 311 hospitals participating in the Get With The Guidelines - Coronary Artery Disease Program from January 01 2005 to December 30 2009. Patient and hospital characteristics, measures and other outcomes were summarized descriptively by ACEI/ARB vs. no ACEI/ARB for ACC/AHA Class I indication. Pearson Chi-square test was used for categorical variables and Wilcoxon test was used for continuous variables. A multivariable logistic regression model with GEE method was fitted to identify influencing factors on ACEI/ARB use at discharge. Results: Among the 60,847 patients with an ACC/AHA Class I indication (left ventricular dysfunction or medical history of heart failure, hypertension or diabetes mellitus), 49,682 (81.7%) received ACEI/ARB with modest increase in treatment over the study period (76.7% to 84.6%). Patient and hospital factors independently associated with ACEI/ARB therapy use in patients meeting ACC/AHA Class I indication are shown in Table 1. Conclusion: Results from this large national registry suggest that one in five eligible patients hospitalized for ACS failed to receive ACC/AHA Class I guideline recommended ACEI/ARB therapy and use varies by patient factors. In particular, the low likelihood of ACEI/ARB post coronary artery bypass grafting surgery (CABG) raises concern. Thus, additional quality improvement efforts are warranted.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".