The SNAPSHOT ACS study: getting the big picture on acute coronary syndrome

How snapshot methodology identifies factors limiting translation of evidence to practice

Translating evidence-based treatments into clinical practice is fundamental to modern health care delivery. Yet numerous studies demonstrate limited uptake of guideline-endorsed treatment recommendations.1,2 Why is this so? There are many possible explanations. Patient characteristics such as age, comorbidity, socioeconomic status, cultural background and frailty are likely to be important. Most trials of novel drugs or devices are funded by industry. Trials are very expensive, and a trial sponsor is understandably keen to ensure that their product is administered to those patients most likely to benefit. Consequently, patients entered into clinical trials are typically younger and have less comorbidity than the broader population of patients with a particular condition. This was found to be the case in a recent Canadian registry report on patients admitted with acute coronary syndrome (ACS), which compared the baseline characteristics of those who were included in clinical trials with the much larger cohort of patients who were not.3 Other variables also limit the translation of evidence-based treatments. For ACS, which requires acute hospital care, the type of hospital (eg, peripheral versus major teaching hospital) and its location (eg, urban versus rural or remote setting) can determine the level of medical expertise and complexity of treatment offered to a patient.