Guidelines for the management of acute coronary syndromes 2006

doi:10.5694/j.1326-5377.2006.tb00304.x

Cited by 11 publications

(4 citation statements)

References 83 publications

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“…Consensus guidelines in New Zealand, the United States, and Europe recommend pharmacotherapy for reducing the morbidity among older patients with congestive heart failure [23,24,25,26]. Both local and international guidelines recommend that, following acute coronary syndrome, patients must be offered antiplatelet therapy as well as statins and β-blockers for secondary prevention [27,28,29]. However, it is widely recognized that the application of clinical guidelines in older people may be inappropriate as current prescribing guidelines are for individual medical conditions and based on evidence derived from clinical trials that generally exclude older people with multiple comorbidities [30].…”

Section: Discussionmentioning

confidence: 99%

Temporal Trends in Polypharmacy and Hyperpolypharmacy in Older New Zealanders over a 9-Year Period: 2005-2013

Nishtala

Salahudeen

2014

Gerontology

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Background: Polypharmacy and hyperpolypharmacy are proxy indicators for inappropriate medicine use. Inappropriate medicine use in older people leads to adverse clinical outcomes. Objective: The objectives of this study were to investigate the prevalence and trends of polypharmacy and hyperpolypharmacy in older people in New Zealand from 2005 to 2013, analyzing the pharmaceutical collections maintained by the Ministry of Health. Methods: A repeated cross-sectional analysis of population-level dispensing data was conducted from January 1, 2005 to December 31, 2013. Polypharmacy and hyperpolypharmacy in individuals were defined as the use of 5-9 medicines and ≥10 medicines, respectively, dispensed concurrently for a period of ≥90 days. Differences in polypharmacy and hyperpolypharmacy between 2005 and 2013 were examined. A multinomial regression model was used to predict sociodemographic characteristics associated with polypharmacy and hyperpolypharmacy. Results: Polypharmacy and hyperpolypharmacy were found to be higher in 2013 compared to 2005 (polypharmacy: 29.5 vs. 23.4%, p < 0.001; hyperpolypharmacy: 2.1 vs. 1.3%, p < 0.001). The risk of polypharmacy and hyperpolypharmacy was higher in females, in those aged 80-84 years, in the Māori population (for polypharmacy) and the Middle Eastern, Latin American, or African population (for hyperpolypharmacy), in people living in the Southern-district health board, and in individuals with increasing deprivation. Conclusion: The population of New Zealand is aging and the number of older people with multiple chronic conditions is increasing. The proportion of older people exposed to polypharmacy and hyperpolypharmacy has increased in 2013 compared to 2005. Our study provides important information to alert health policy makers, researchers, and clinicians about the dire need to reduce the medication burden in older New Zealanders.

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Section: Discussionmentioning

confidence: 99%

Temporal Trends in Polypharmacy and Hyperpolypharmacy in Older New Zealanders over a 9-Year Period: 2005-2013

Nishtala

Salahudeen

2014

Gerontology

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“… 2 Ischemic heart disease may present with a variety of symptoms, eg, a symptom complex called acute coronary syndrome (ACS), which may lead to a diagnosis of one of unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), or ST-segment elevation myocardial infarction (STEMI). The former is a clinical diagnosis, whereas the latter two are diagnosed from the abnormalities seen on the EKG, possibly complemented by serum enzyme assays, eg, of troponin C. 3 …”

Section: Introductionmentioning

confidence: 99%

Differences in Clinical Nature and Outcome Among Young Patients Suffering from an Acute Coronary Syndrome

Al-Shahrani¹,

Katbi²,

Al-Sharydah³

et al. 2021

JBM

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Purpose: Acute coronary syndrome (ACS) is a life-threatening cardiac disease identified by acute, regional reductions in coronary blood flow, resulting in myocardial ischemia, or infarction, and manifesting as discomfort in the chest area, neck, or arms. Frequently, ACS is provoked by an atherosclerotic plaque; therefore, coronary atherosclerosis is converted into a chronic disease to an acute medical emergency. The purpose of this study was to explore the differences among these variables in patients less than 45 years of age suffering from this major health problem compared to older adults admitted with an ACS diagnosis, and to adopt an optimized temporary management. Patients and Methods: A retrospective chart review study was conducted on a total of 652 ACS patients admitted at King Fahad Hospital of the University (KFHU) between 2015 and 2020. The patients' medical records were utilized for obtaining demographic data, presenting symptoms, risk factors, and clinical outcomes. Results: Overall, 652 patients were enrolled. Of these, 109 patients (16.7%) were under 45, with a mean age of 38 ± 7. Younger patients showed a higher rate of palpitation (23.9% versus. 13.6%; P = 0.019). A positive smoking history and a family history of CAD were seen more often in younger patients (42.2% vs 27.3%, P < 0.001; 22.9% vs 9.4%, P < 0.001, respectively). Older patients had greater renal impairment with higher creatinine (median = 1.10 mg/dl (range, 0.3-13.0) vs 1.0 (0.3-19.0; p = 0. 001), BUN (median = 16.0 (mange, 0.9-141.0) vs 12.0 (0.9-49.0); P < 0.001)). Younger patients had higher levels of LDL and total cholesterol (median 138c. 115; p < 0.001) and cholesterol (median 209 vs 178.5; p < 0.001). Hospital mortality was 0.9% in younger patients versus 7.4% in older patients (P = 0.004). Conclusion: Palpitations, smoking, family history, higher LDL levels, and total cholesterol levels were more prevalent in adults younger than 45 years old with ACS. Impaired renal function, hypertension, and diabetes were more in older patients with ACS.

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“…Acute myocardial infarction (AMI) accounts for almost half of CVD-related deaths globally ( Roth et al, 2017 ). Based on clear evidence of benefit from large-scale randomized controlled trials, all international guidelines recommend long-term secondary prevention medications for patients who have had an AMI, unless contraindicated ( Guidelines for the Management of Acute Coronary Syndromes, 2006 ; Smith et al, 2006 ; National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand, 2012 ; National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk, 2012 ; Roffi et al, 2016 ; Ibanez et al, 2017 ; Karmali and Lloyd-Jones, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Prior Cardiovascular Treatments—A Key Characteristic in Determining Medication Adherence After an Acute Myocardial Infarction

et al. 2022

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Objective: To investigate long-term adherence to guideline-recommended cardioprotective medications following hospitalization for an acute myocardial infarction (AMI), and identify characteristics associated with adherence.Methods: An Australian population-based cohort study was used to identify participants who had their first AMI between 2006 and 2014 and were alive after 12 months. Linked routinely collected hospital, and prescription medication claims data was used to study adherence over time. Predictors and rates of adherence to both lipid-lowering medication and renin-angiotensin system blockade at 12 months post-AMI was assessed.Results: 14,200 people (mean age 69.9 years, 38.7% female) were included in our analysis. At 12 months post-AMI, 29.5% (95% CI: 28.8–30.3%) of people were adherent to both classes of medication. Individuals receiving treatment with both lipid-lowering medication and renin-angiotensin system blockade during the 6 months prior to their AMI were over 9 times more likely to be adherent to both medications at 12 months post-AMI (66.2% 95% CI: 64.8–67.5%) compared to those with no prior medication use (treatment naïve) (7.1%, 95% CI: 6.4–7.9%). Prior cardiovascular treatment was the strongest predictor of long-term adherence even after adjusting for age, sex, education and income.Conclusions: Despite efforts to improve long-term medication adherence in patients who have experienced an acute coronary event, considerable gaps remain. Of particular concern are people who are commencing guideline-recommended cardioprotective medication at the time of their AMI. The relationship between prior cardiovascular treatments and post AMI adherence offers insight into the support needs for the patient. Health care intervention strategies, strengthened by enabling policies, are needed to provide support to patients through the initial months following their AMI.

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Guidelines for the management of acute coronary syndromes 2006

Cited by 11 publications

References 83 publications

Temporal Trends in Polypharmacy and Hyperpolypharmacy in Older New Zealanders over a 9-Year Period: 2005-2013

Temporal Trends in Polypharmacy and Hyperpolypharmacy in Older New Zealanders over a 9-Year Period: 2005-2013

Differences in Clinical Nature and Outcome Among Young Patients Suffering from an Acute Coronary Syndrome

Prior Cardiovascular Treatments—A Key Characteristic in Determining Medication Adherence After an Acute Myocardial Infarction

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