Optimal medical therapy at discharge in patients with acute coronary syndromes: Temporal changes, characteristics, and 1-year outcome

Yan, Andrew T.; Yan, Raymond T.; Tan, Mary; Huynh, Thao; Soghrati, Kamyar; Brunner, Lawrence J.; DeYoung, Paul; Fitchett, David; Langer, Anatoly

doi:10.1016/j.ahj.2007.07.040

Cited by 143 publications

(133 citation statements)

References 29 publications

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“…However, it seems to be better than results reported by Danchin et al [10] in French patients admitted to intensive care units in 2000 for acute myocardial infarction; only 27% of these patients received the quadritherapy at hospital discharge. Yan et al [36] reported a significant increase in the discharge use of all 4 classes of medications over time with 29% and 52% of patients prescribed optimal medical The rates of persistence for EBCM as well as for each compound separately were high in PREVENIR-5 patients as already observed in the most recent studies. In PREVENIR-4 survey carried out in 2006, 80% of coronary patients were still taking the quadritherapy 14 months on average after hospital discharge [3].…”

Section: Comparison Between Nn and Lrsupporting

confidence: 52%

Prediction of persistence of combined evidence-based cardiovascular medications in patients with acute coronary syndrome after hospital discharge using neural networks

Bourdès¹,

Ferrières

Amar

et al. 2011

Med Biol Eng Comput

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Section: Comparison Between Nn and Lrsupporting

confidence: 52%

Prediction of persistence of combined evidence-based cardiovascular medications in patients with acute coronary syndrome after hospital discharge using neural networks

Bourdès¹,

Ferrières

Amar

et al. 2011

Med Biol Eng Comput

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“…A recent study, published last month, evaluated the patient characteristics associated with medical therapy at hospital discharge for ACS. 17 The use of optimal medical therapy (defined as discharge on antiplatelet/anticoagulant, beta-blocker, lipid-modifying agent, and ACE inhibitor in those without contraindications) was reported in 35.8% (2,091/5,833) of patients during October 2002-December 2003. This study found that patients who had a previous MI had a 35.0% rate of use of optimal medical therapy compared with a 30.9% rate for those without previous MI (P = 0.001).…”

mentioning

confidence: 99%

Use of Secondary Prevention Drug Therapy in Patients With Acute Coronary Syndrome After Hospital Discharge

Lee¹,

Cooke²,

Robertson³

2008

JMCP

111

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BACKGROUND: Acute coronary syndrome includes life-threatening clinical conditions ranging from unstable angina to non-Q-wave myocardial infarction and Q-wave myocardial infarction that are a major cause of emergency medical care and hospitalization in the United States. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the management of patients with unstable angina and non-ST-segment elevation myocardial infarction (2002)(2003)(2004) recommend (1) angiotensinconverting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) for ACE inhibitor intolerance, (2) beta-blockers, and (3) statins for long-term treatment of patients after an acute coronary event.OBJECTIVE: To examine rates of use of 3 key evidence-based drug therapies (ACE inhibitors/ARBs, beta-blockers, and statins) after hospital discharge for patients with acute coronary syndromes (ACS).METHODS: The study cohort was identified using medical claims from commercial health plans within a managed care organization located in the Mid-Atlantic states, with approximately 3.4 million members with medical benefits of whom 1.2 million members (35.3%) had pharmacy benefits. Members were included if they were (1) aged ≥ 18 years, (2) Pharmacy claims for ACE inhibitors, ARBs, beta-blockers, and statins were obtained for 18 months following each index date, defined as the earliest ACS diagnosis date during the identification period. Utilization was defined as the member having at least 1 pharmacy claim within each class from index date to 3 months post-index date. Five time periods were examined to assess therapy: -180 to 0 days (6 months prior), 0 to 90 days (3 months), 0 to 180 days (6 months), 0 to 365 days (12 months), and 0 to 548 days (18 months) following the index date. ACE inhibitors and ARBs were considered together (i.e., a patient had to have at least 1 pharmacy claim for an ACE inhibitor or an ARB). Logistic regression analyses were used to predict use of the 3 drug classes for patients with different clinical (diagnosis and prior use) and demographic (sex and age) characteristics.RESULTS: The study cohort included 1,135 patients (0.27% of 424,526 continuously enrolled members) with ACS as defined by ICD-9-CM codes in medical claims from July 1, 2003, to June 30, 2004. Nearly 65% of the sample patients were men (n = 734 men and n = 401 women), with a mean (standard deviation [SD]) age of 63.8 (SD 13.1) years. Of the 1,135 members with ACS, 588 (51.8%) had at least 1 pharmacy claim for an ACE inhibitor or ARB, 725 (63.9%) for a beta-blocker, and 710 (62.6%) for a statin during the 3-month follow-up period; receipt of at least 1 prescription in all 3 classes was found in 339 (29.9%) of patients. Patients who were aged < 45 years, 65-79 years, and ≥ 80 years were significantly less likely than patients aged 45-64 years to receive statins (P < 0.05). In addition, patients who were aged ≥ 80 years were significantly less likely to receive ACE inhibitors/ARBs (P = 0.003), beta-blockers (P < 0.001), or ...

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“…Second, there is a secular trend for increased use of cardioprotective drugs (13). Regardless of renal function, overall rates of cardioprotective drug use were indeed much higher in our cohort and in another recent report (7) compared with earlier ones (8,9).…”

Section: Discussionmentioning

confidence: 44%

“…Finally, physicians may be fearful of worsening renal function in CKD patients by performing invasive interventions. Most previous reports recruited patients who experienced ACS in the mid-1990s, whereas a secular trend toward increased use of cardioprotective drugs has been demonstrated in recent years (12,13). Previous work on the topic has often come from large registries that may lack clinical information on some comorbidities and concomitant therapies (10,11).…”

mentioning

confidence: 99%

Therapeutic Management in Patients with Renal Failure who Experience an Acute Coronary Syndrome

Cardinal¹,

Bogaty²,

Madore³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Prior reports have suggested that patients with impaired renal function receive less aggressive care after an acute coronary syndrome (ACS). The aim of this study was to determine whether this held true in a contemporary cohort, after thorough adjustment for cotreatments/comorbidities. Design, setting, participants, & measurements: Patients who were admitted for an ACS in eight participating hospitals were stratified into three groups according to estimated creatinine clearance (CrC): less than 45 ml/min, 45 to 60 ml/min, and reference >60 ml/min.Results Conclusions: These results suggest that in patients with ACS, the extent of undertreatment due to chronic kidney disease is less than reported previously, which is partially explained by more complete adjustment for cotreatments/comorbidities.

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Optimal medical therapy at discharge in patients with acute coronary syndromes: Temporal changes, characteristics, and 1-year outcome

Cited by 143 publications

References 29 publications

Prediction of persistence of combined evidence-based cardiovascular medications in patients with acute coronary syndrome after hospital discharge using neural networks

Prediction of persistence of combined evidence-based cardiovascular medications in patients with acute coronary syndrome after hospital discharge using neural networks

Use of Secondary Prevention Drug Therapy in Patients With Acute Coronary Syndrome After Hospital Discharge

Therapeutic Management in Patients with Renal Failure who Experience an Acute Coronary Syndrome

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