Journal Articles

Translation of acute coronary syndrome therapies: From evidence to routine clinical practice

November 12, 2014

Translation of acute coronary syndrome therapies: From evidence to routine clinical practice  12 November 2014, American Heart Journal, Martin Putera, MDa, Robin Roark, MD, MBAb, Renato D. Lopes, MD, PhDb, Krishna Udayakumar, MD, MBAa, b, c, Eric D. Peterson, MD, MPHb, Robert M. Califf, MDb, c, Bimal R. Shah, MD, MBAb, d

Translation of acute coronary syndrome therapies: From evidence to routine clinical practice

  • Duke-National University of Singapore Graduate Medical School, Singapore
  • b Duke University School of Medicine, Durham, NC
  • c Duke Clinical Research Institute, Durham, NC
  • d Duke Translational Medicine Institute, Durham, NC

Translation of acute coronary syndrome therapies: From evidence to routine clinical practice

Abstract

Background

The use of evidence-based therapies has improved the outcome of patients with acute coronary syndrome (ACS), but there is a time lag between the generation of clinical evidence and its application in routine clinical practice. We sought to quantify temporal lags in the lifecycle of American College of Cardiology (ACC)/American Heart Association (AHA) Class IA ACS therapies.

Methods

Using current and historical ACC/AHA guideline publications, we retrieved publication dates of pivotal clinical trials (PCTs) and Class IA guideline-recommended therapies for ST-elevation myocardial infarction (STEMI) and unstable angina (UA)/non-STEMI (NSTEMI) patients. Clinical practice uptake data for each therapy was retrieved from NRMI, CRUSADE, and ACTION Registry-GTWG, which are registries containing publicly available peer-reviewed data. Descriptive data was calculated and compared for each phase of the evidence lifecycle for both STEMI and UA/NSTEMI drug classifications.

Results

We identified 11 Class IA- and four Class IB/IC-recommended therapies for acute, in-hospital, and discharge use for STEMI or UA/NSTEMI patients. The median time lags were 2 years (interquartile range [IQR] 1–4 years) from PCT to practice guideline recommendation, 14 years (IQR 11–15 years) from guideline recommendation to 90% practice uptake, and overall, a 16-year median (IQR 13–19 years) from PCT to 90% practice uptake.

Conclusions

The time of PCT publication to meaningful uptake of Class IA ACS therapies into clinical practice took a median of 16 years. This significant time lag indicates systemic barriers to the translation of therapeutics into routine clinical practice.

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