Background: Patients with acute coronary syndromes (ACS) and a history of atrial fibril-lation (AF) have indications for both dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC). Triple therapy (TT), the combination of DAPT and OAC, is recommended in guidelines. We examined studies comparing clinical outcomes on DAPT versus TT for patients with AF and ACS.Methods: We searched Medline, Medline pending, EMBASE and Evidence-Based Medicine Re-views databases for studies published between January 2000 to December 2016 in AF patients with ACS that compared DAPT and TT that reported ischaemic and/or bleeding outcomes. Studies that were not purely an AF population were excluded.Results: Ten studies were included in the review, all of which were observational, 8 of which were retrospective. None of the studies detailed the specifics of treatment allocation. All but one were of AF patients with a mix of stable coronary disease and ACS patients. TT was associated with in-creased bleeding when compared to DAPT, with adjusted odds ratios ranging from 1.25 to 6.84. While the largest study reported a reduction in stroke associated with TT (odds ratio 0.67), two other studies reported non-significant increases in stroke with TT. Variable composite ischaemic endpoints were reported, none showing a statistical significant difference between DAPT and TT.Conclusion: In patients with ACS and AF, TT is likely to be associated with increased risk of bleed-ing, without a clear reduction in ischaemic endpoints. The quality of the evidence to support current guidelines for this patient group was generally poor.

s S77Conclusions: Indoor flowering plants in the rooms of post-ACS patients during the inpatient period reduced patient depressive symptoms in the acute phase, however there was no effect on anxiety. This effect on depressive symptoms did not persist three months post discharge. http://dx.

Background: Dual antiplatelet therapy is recommended for patients with acute coronary syndromes (ACS). The PLATO study reported a mortality advantage of ticagrelor compared with clopidogrel when added to aspirin as the second antiplatelet agent after ACS. Substudies from PLATO reported that this benefit occurred regardless of age or level of renal function. Both NZ and international guidelines recommend ticagrelor in preference to clopidogrel. Our aim was to investigate the current use of anti-platelet agents in NZ ACS patients, and in particular the use of ticagrelor compared with clopidogrel in older patients and those with renal impairment.Methods: 2280 consecutive patients with completed records presenting with myocardial infarction who had a coronary angiogram between Jan 2015 and June 2015 were recorded in the ANZACS-QI registry. Patients referred for coronary artery bypass surgery or who died in hospital were excluded. Prescription of anti-platelet agents (aspirin, clopidogrel and ticagrelor) at discharge is recorded in the registry.Results: 90% of patients received dual anti-platelet therapy. The use of aspirin was high and independent of age, gender or renal function. Older patients and those with renal impairment were less likely to be prescribed ticagrelor as the second anti-platelet agent at discharge.