{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:32:38Z","timestamp":1789450358867,"version":"build-2803163510"},"reference-count":44,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2015,7,24]]},"published-print":{"date-parts":[[2015,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Quantitative risk assessment in unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI), by using cardiac risk scores, is recommended in international guidelines. However, a gap between recommended care and actual practice exists, as these instruments seem underused in practice. The present study aimed to determine the extent of cardiac risk score use and to study factors associated with lower or higher cardiac risk score use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>13 hospitals throughout the Netherlands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A retrospective chart review of 1788 charts of patients with UA and NSTEMI, discharged in 2012.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcomes<\/jats:title>\n                    <jats:p>The extent of cardiac risk score use reflected in a documented risk score outcome in the patient's chart. Factors associated with cardiac risk score use determined by generalised linear mixed models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 57% (n=1019) of the charts, physicians documented the use of a cardiac risk score. Substantial variation between hospitals was observed (16.7\u201387%), although this variation could not be explained by the presence of on-site revascularisation facilities or a hospitals\u2019 teaching status. Obese patients (OR=1.49; CI 95%1.03 to 2.15) and former smokers (OR=1.56; CI 95%1.15 to 2.11) were more likely to have a cardiac risk score documented. Risk scores were less likely to be used among patients diagnosed with UA (OR=0.60; CI 95% 0.46 to 0.77), in-hospital resuscitation (OR=0.23; CI 95% 0.09 to 0.64), in-hospital heart failure (OR=0.46; CI 95% 0.27 to 0.76) or tachycardia (OR=0.45; CI 95% 0.26 to 0.75).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite recommendations in cardiac guidelines, the use of cardiac risk scores has not been fully implemented in Dutch practice. A substantial number of patients did not have a cardiac risk score documented in their chart. Strategies to improve cardiac risk score use should pay special attention to patient groups in which risk scores were less often documented, as these patients may currently be undertreated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2015-008523","type":"journal-article","created":{"date-parts":[[2015,11,25]],"date-time":"2015-11-25T01:41:14Z","timestamp":1448415674000},"page":"e008523","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["A cross-sectional multicentre study of cardiac risk score use in the management of unstable angina and non-ST-elevation myocardial infarction"],"prefix":"10.1136","volume":"5","author":[{"given":"Josien","family":"Engel","sequence":"first","affiliation":[{"name":"Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ineke","family":"van der Wulp","sequence":"additional","affiliation":[{"name":"Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martine","family":"de Bruijne","sequence":"additional","affiliation":[{"name":"Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cordula","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands"},{"name":"NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2015,11,24]]},"reference":[{"key":"2025120600541688000_5.11.e008523.1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.297.17.1892"},{"key":"2025120600541688000_5.11.e008523.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0908610"},{"key":"2025120600541688000_5.11.e008523.3","unstructured":"Lopez AD , Murray CJ . The global burden of disease. A comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge, MA: Harvard University Press, 1996."},{"key":"2025120600541688000_5.11.e008523.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)07492-2"},{"key":"2025120600541688000_5.11.e008523.5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0030442"},{"key":"2025120600541688000_5.11.e008523.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2005.08.006"},{"key":"2025120600541688000_5.11.e008523.7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.16.1912"},{"key":"2025120600541688000_5.11.e008523.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2004.06.021"},{"key":"2025120600541688000_5.11.e008523.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2006.10.008"},{"key":"2025120600541688000_5.11.e008523.10","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr236"},{"key":"2025120600541688000_5.11.e008523.11","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.181940"},{"key":"2025120600541688000_5.11.e008523.12","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000133"},{"key":"2025120600541688000_5.11.e008523.13","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.163.19.2345"},{"key":"2025120600541688000_5.11.e008523.14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38985.646481.55"},{"key":"2025120600541688000_5.11.e008523.15","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.7.835"},{"key":"2025120600541688000_5.11.e008523.16","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2003.031369"},{"key":"2025120600541688000_5.11.e008523.17","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.22.2557"},{"key":"2025120600541688000_5.11.e008523.18","doi-asserted-by":"publisher","DOI":"10.1007\/BF03086144"},{"key":"2025120600541688000_5.11.e008523.19","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi187"},{"key":"2025120600541688000_5.11.e008523.20","doi-asserted-by":"publisher","DOI":"10.1097\/HPC.0b013e3181ec36d8"},{"key":"2025120600541688000_5.11.e008523.21","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehm004"},{"key":"2025120600541688000_5.11.e008523.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.12.010"},{"key":"2025120600541688000_5.11.e008523.23","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehm084"},{"key":"2025120600541688000_5.11.e008523.24","doi-asserted-by":"publisher","DOI":"10.1586\/erc.12.20"},{"key":"2025120600541688000_5.11.e008523.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2005.05.046"},{"key":"2025120600541688000_5.11.e008523.26","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.10.1009"},{"key":"2025120600541688000_5.11.e008523.27","first-page":"177","article-title":"Intervention in acute coronary syndromes: do patients undergo intervention on the basis of their risk characteristics? The Global Registry of Acute Coronary Events (GRACE)","volume":"93","author":"Fox","year":"2007","journal-title":"DHeart"},{"key":"2025120600541688000_5.11.e008523.28","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2005.079673"},{"key":"2025120600541688000_5.11.e008523.29","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2007.78"},{"key":"2025120600541688000_5.11.e008523.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.06.050"},{"key":"2025120600541688000_5.11.e008523.31","doi-asserted-by":"publisher","DOI":"10.1007\/s12471-014-0574-4"},{"key":"2025120600541688000_5.11.e008523.32","unstructured":"VMSzorg. Optimal care in Acute Coronary Syndromes [Original title in Dutch: Optimale zorg in Acute Coronaire Syndromen]. Dutch National Patient Safety Programme. 2010. Http:\/\/www.vmszorg.nl\/Themas\/ACS"},{"key":"2025120600541688000_5.11.e008523.33","first-page":"1","article-title":"MICE: Multivariate Imputation by Chained Equations in R","volume":"45","author":"van Buuren","year":"2011","journal-title":"J Stat Software"},{"key":"2025120600541688000_5.11.e008523.34","unstructured":"R Core Team. R: a language and environment for statistical computing. 2013. Vienna, Austria, R Foundation for Statistical Computing. http:\/\/www.R-project.org"},{"key":"2025120600541688000_5.11.e008523.35","unstructured":"McCulloch CE , Searle SR , Neuhaus JM . Generalized, linear, and mixed models. 2nd edn. New Jersey: John Wiley & Sons, 2008."},{"key":"2025120600541688000_5.11.e008523.36","doi-asserted-by":"crossref","unstructured":"Kumbhani DJ , Fonarow GC , Cannon CP , et al . Predictors of adherence to performance measures in patients with acute myocardial infarction. Am J Med 2013;126:74.e1\u20139. doi:10.1016\/j.amjmed.2012.02.025","DOI":"10.1016\/j.amjmed.2012.02.025"},{"key":"2025120600541688000_5.11.e008523.37","doi-asserted-by":"crossref","first-page":"26","DOI":"10.5694\/j.1326-5377.2002.tb04627.x","article-title":"Guideline-discordant care in acute myocardial infarction: predictors and outcomes","volume":"177","author":"Scott","year":"2002","journal-title":"Med J Aust"},{"key":"2025120600541688000_5.11.e008523.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2005.05.019"},{"key":"2025120600541688000_5.11.e008523.39","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2003.11.028"},{"key":"2025120600541688000_5.11.e008523.40","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2004.09.013"},{"key":"2025120600541688000_5.11.e008523.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2003.11.014"},{"key":"2025120600541688000_5.11.e008523.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2007.08.001"},{"key":"2025120600541688000_5.11.e008523.43","doi-asserted-by":"publisher","DOI":"10.1097\/HPC.0b013e318204eb8b"},{"key":"2025120600541688000_5.11.e008523.44","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14546-1"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2015-008523","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T08:54:22Z","timestamp":1765011262000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2015-008523"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,11]]},"references-count":44,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2015,11,24]]},"published-print":{"date-parts":[[2015,11]]}},"alternative-id":["10.1136\/bmjopen-2015-008523"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2015-008523","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,11]]}}}