Hospitals that participate in clinical trials provide better care for patients with non–ST-segment elevation acute coronary syndrome, compared with hospitals that do not, according to a study in the March 24 issue of the Archives of Internal Medicine.
Sumit R. Majumdar, MD, from the department of medicine at the University of Alberta in Edmonton, Alberta, and colleagues reviewed data from 174,062 patients from 494 hospitals participating in CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation).
The participation in clinical trials was also significantly associated with adherence to American College of Cardiology (ACC) and American Heart Association (AHA) treatment guidelines, the authors wrote.
The researchers classified the hospitals into tertiles by percentage of patients concurrently enrolled in non–ST-segment elevation acute coronary syndrome trials.
Overall, Majumdar and colleagues observed 4,590 patients (2.6 percent) enrolled in trials, ranging from 0 percent (145 hospitals) to low-enrollment tertile (1 percent) to high-enrollment tertile (4.9 percent). The composite guideline adherence score increased with increasing tertiles of trial participation: 76.9 percent vs. 78.3 percent vs. 81.1 percent.
The hospitals that participated in trials had higher adjusted guideline adherence than nonparticipating hospitals (low enrollment, 0.8 percent greater; and high enrollment, 2.5 percent greater), according to the authors.
They also found that in-hospital mortality decreased with increasing trial participation: 5.9 percent vs. 4.4 percent vs. 3.5 percent.
The researchers found that patients treated at hospitals that participated in trials had significantly lower mortality than patients treated at nonparticipating hospitals (low enrollment adjusted odds, 0.9; and high enrollment adjusted odds, 0.8.
“We did not survey all 494 hospitals to ascertain the level of penetration of various quality improvement interventions nor did we use qualitative methods to describe institutional culture. This is certainly a worthwhile line of inquiry for future research,” the authors observed.