Acute coronary syndrome (ACS) is among the most common causes of emergency hospital admission and a major cause of morbidity and mortality worldwide. There is approximately 1.8 million hospitalizations for ACS in the United States; out of the eight million presenting with chest pain in the emergency departments, which suggests an ischemic origin. The large numbers of coronary artery disease (CAD) hospitalization resulted in large-scale clinical trials and registries which have provided abundant data on hundreds of thousands of patients which resulted in defining guidelines through evaluation of the quality of care and outcomes for patients with ACS. These guidelines are dedicated to the assessment of patients with ACS, have existed in the United States since 1994.

Despite considerable investment in the development and nationwide distribution of guidelines, the Center for Medicare and Medicaid Services Cooperative Cardiovascular Project reported the quality of care for Medicaid beneficiaries with acute myocardial infarction (AMI) was far from optimal. Many subsequent studies have also shown similar disappointing adherence to the therapeutic recommended in published guidelines.

To address this issue, the “Advance Cardiac Admission Program” (ACAP) focusing on a critical pathways approach for risk stratification and medical management of patients admitted with ACS has been launched at St. Luke’s-Roosevelt Hospital Center. The ACAP was based on the hypothesis that simplified algorithmic approach in management of patients with cardiac disease as well as initiation and optimization of therapy according to established guidelines in the hospital setting would result in higher medications utilization both during hospitalization and longer-term follow-up and higher achievement of standard goals.

Implementation of this program involved the use of an algorithm based treatment pathways, standardized admission orders, patients education, and follow up of treatment and major adverse cardiac events. We believe that simplified risk stratification as well as prioritization and algorithmic treatment according to guidelines have the potential to significantly increase treatment utilization and improve the outcome of patients suffering from CAD.

This web site will serve as an easy access to all health care providers and patients in providing information about all implemented pathways at St. Luke's-Roosevelt Hospital Center.

Eyal Herzog, MD, FACC

Director Cardiac Care Unit

St. Luke's-Roosevelt Hospital Center

Associate Professor of Clinical Medicine

Columbia University College of Physicians and Surgeons