Improved adherence to practice guidelines yields better outcome in high‐risk patients with acute coronary syndrome without ST elevation: findings from nationwide FINACS studies

. Vikman S, Airaksinen KEJ, Tierala I, Peuhkurinen K, Majamaa‐Voltti K, Niemelä M, Tuunanen H, Nieminen MS, Niemelä K (Tampere University Hospital, Tampere; University of Turku, Turku; University of Helsinki, Helsinki; University of Kuopio, Kuopio; and University of Oulu, Oulu; Finland). Improved adherence to practice guidelines yields better outcome in high‐risk patients with acute coronary syndrome without ST elevation: findings from nationwide FINACS studies. J Intern Med 2004; 256: 316–323. Objectives. Treatment options for acute coronary syndrome (ACS) without ST elevation have evolved rapidly during the recent years, but the successful implementation of practice guidelines incorporating new treatments into practice has been challenging. In this study, we evaluate whether targeted educational intervention could improve adherence to treatment guidelines of ACS without ST elevation. Design, setting and subjects. A previous study, FINACS I, evaluated the treatment and outcome of 501 consecutive non‐ST elevation ACS patients that were referred in early 2001 to nine hospitals, covering nearly half of the Finnish population. That study revealed poor adherence to ESC guidelines, so targeted educational intervention on optimal practice was arranged before the second study (FINACS II), which was performed in the same hospitals using the same protocol as FINACS I. FINACS II, undertaken in early 2003, evaluated 540 consecutive patients. Interventions. Targeted educational programmes on optimal practice. Main outcome measures. The use of evidence‐based therapies in non‐ST elevation ACS patients. In‐hospital event‐free (death, new myocardial infarction, refractory angina, readmission with unstable angina and transient cerebral ischaemia/stroke) survival, and event‐free survival at 6 months. Results. Baseline characteristics and risk markers were similar in both studies, and no significant changes in resources were seen. In 2003, the in‐hospital use of statins, ACE‐inhibitors, clopidogrel and glycoprotein (GP) IIb/IIIa receptor antagonists increased significantly, and in‐hospital angiography was performed more often, especially in high‐risk patients (59% vs. 45%, P