Intensive lipid‐lowering therapy in the 12 months after an acute coronary syndrome in Australia: an observational analysis

Brieger, David; Weaver, James; Kritharides, Leonard

doi:10.5694/mja2.50323

Cited by 8 publications

(13 citation statements)

References 9 publications

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“…However, initiation of secondary prevention therapies at hospital discharge can improve medication adherence and long-term outcomes [24]. Given the substantial cardiovascular benefits of SGLT2 inhibitors, and that they are strongly recommended for cardiovascular risk reduction in people Values are given as n (%).…”

Section: Discussionmentioning

confidence: 99%

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Implementing simple algorithms to improve glucose and lipid management in people with diabetes and acute coronary syndrome

et al. 2019

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Aim Diabetes mellitus is associated with increased risk of adverse outcomes following acute coronary syndrome. Translating evidence‐based recommendations into practice is necessary to improve outcomes. We evaluated whether implementing algorithms to guide inpatient care improved glycaemic control, and increased use of sodium–glucose co‐transporter 2 (SGLT2) inhibitors and lipid‐lowering medication in a tertiary cardiac unit. Method A 3‐month audit (phase 1) was conducted to evaluate hyperglycaemia and dyslipidaemia management, and medication prescriptions. Consecutive people with diabetes admitted for acute coronary syndrome were prospectively identified. Target blood glucose level was defined as 5–10 mmol/l. A multidisciplinary committee designed and implemented decision‐support algorithms plus education. A 3‐month post‐implementation audit (phase 2) was conducted. Results There were 104 people in phase 1 and 101 in phase 2, with similar characteristics [HbA1c 64 ± 20 mmol/mol vs. 61 ± 21 mmol/mol (8.0 ± 1.8% vs. 7.8 ± 1.9%]. Post implementation, the incidence of blood glucose levels > 10 mmol/l was lower [phase 1: 46.4% vs. phase 2: 31.8%, rate ratio (RR) = 0.77, 95% confidence intervals (CI) 0.60–0.98; P = 0.031], without a difference in blood glucose levels < 5mmol/l (phase 1: 4.9% vs. phase 2: 4.5%, RR = 1.20, 95% CI 0.70–2.08; P = 0.506). SGLT2 inhibitor prescriptions increased significantly (baseline to discharge: 12.5% to 15.4% vs. 7.9% to 24.8%; P = 0.007) but high‐intensity statin prescriptions did not (baseline to discharge: 35.6% to 72.1% vs. 40.6% to 85.1%; P = 0.074). Prescription rates of non‐statin lipid‐lowering medications were not significantly increased. Conclusions Implementing decision‐support algorithms was associated with improved inpatient glycaemic control and increased use of cardioprotective therapies at discharge in people with diabetes and acute coronary syndrome.

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Section: Discussionmentioning

confidence: 99%

“…Medications such as ezetimibe or monoclonal antibodies to proprotein convertase subtilisin‐kexin type 9 (PCSK9) when added to statins, can improve outcomes after acute coronary syndrome . However, many people do not receive high‐intensity statins following an acute coronary syndrome .…”

Section: Introductionmentioning

confidence: 99%

Implementing simple algorithms to improve glucose and lipid management in people with diabetes and acute coronary syndrome

et al. 2019

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“…This is particularly important when transitioning from hospital to community care, where a key determinant of longer-term medication compliance is structured discharge planning and being prescribed the medication at the time of discharge. [18][19] There are also disparities between TGA registered indications and what is permissible on the PBS. A combination Figure 3 New approach for glycaemic therapy in patients with type 2 diabetes adapted from the joint American Diabetes Association and European Association for the Study of Diabetes guideline (reference 10).…”

Section: Current Guidelines For Treating People With Type 2 Diabetesmentioning

confidence: 99%

“…This prerequisite of initial treatment failure, return patient visits and repetitive blood tests may make it arduous for both prescribers and patients to initiate these therapies. This is particularly important when transitioning from hospital to community care, where a key determinant of longer‐term medication compliance is structured discharge planning and being prescribed the medication at the time of discharge 18–19 …”

Section: Navigating the Pharmaceutical Benefits Schemementioning

confidence: 99%

Priorities and practicalities of prescribing diabetes medicines with cardiovascular and renal protective effects: an Australian perspective

Hitchen

Lan

Fegan

et al. 2020

Internal Medicine Journal

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Recent cardiovascular safety trials on sodium‐glucose co‐transporter 2 inhibitors and glucagon‐like peptide‐1 receptor agonists have demonstrated the significant cardiovascular and renal benefits of these medications. Diabetes organisations have revised their medication guidelines to include a focus on disease outcomes for cardiovascular disease, heart failure and renal disease. This article summarises latest evidence, guideline recommendations and current Australian Pharmaceutical Benefits Scheme requirements.

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“…To the Editor : The efficacy of evidence‐based doses of statins is well established. The poor compliance with high intensity lipid‐lowering pharmacotherapy reported by Brieger and colleagues in the CONCORDANCE study has been noted in many studies . Compliance is related to several factors, including patients’ perspectives and concerns about quality of life and possible adverse effects compared with potential benefits.…”

mentioning

confidence: 99%