Optimal medical therapy for secondary prevention after an acute coronary syndrome: 18-month follow-up results at a tertiary teaching hospital in South Korea

Byeon, Hee Ja; Yang, Yeon-Mi; Choi, Eun Joo

doi:10.2147/tcrm.s99869

Cited by 7 publications

(4 citation statements)

References 40 publications

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“…We believe that the reason behind the low prescribing of these medications is the presence of clinical factors/contraindications that hinder the use of full EBM. In line with previous findings from Oman [ 4 ], patients with ACS were found to be younger in this study compared to other countries [ 21 , 22 , 28 ].…”

Section: Discussionsupporting

confidence: 93%

The Prevalence and Impact of Evidence-Based Medications on Cardiovascular and Cerebrovascular Outcomes in Patients with Acute Coronary Syndrome Post-Revascularization in Oman

et al. 2023

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Objectives: International cardiovascular guidelines recommend prescribing a combination of five evidence-based medications (EBM) for acute coronary syndrome (ACS) patients post-revascularization. This study aims to assess the prevalence and impact of prescribing the full (five medications) versus partial (four medications or fewer) EBM combination on major adverse cardiovascular and cerebrovascular events (MACCE) in patients with ACS post-revascularization. Methods: Data from patients with ACS who had revascularization between January 2016 and September 2021 were collected retrospectively. Patients were then followed up until March 2022 for MACCE. Results: The full EBM combination was prescribed to 70% of the patients. However, after taking into account the presence of contraindications and clinical factors, the actual adherence to the guidelines was 95%. Patients who received the full EBM combination were younger (58 versus 62 years; p = 0.0 and 3) and had lower rates of chronic kidney disease (11% versus 41%; p < 0.001) and heart failure (9% versus 20%; p = 0.012) when compared to patients who received the partial EBM. Compared to the partial EBM group, the full EBM group was associated with lower MACCE rates (54% versus 37%, p = 0.012). After employing the propensity score technique utilizing the 1:1 nearest neighbor matching method without replacement, the univariate findings were further re-affirmed with those on full EBMs (compared to those on partial EBMs) associated with a significant reduction in the MACCE rate (average treatment effect of −25%; 95% confidence interval: −10–−40%; p = 0.001). Conclusions: The full EBM utilization was significantly high in our setting and in line with international guidelines. The full EBM combination was predominantly prescribed in younger and less comorbid patients and was associated with lower MACCE rates. The findings were further reaffirmed by the propensity score matching method.

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Section: Discussionsupporting

confidence: 93%

The Prevalence and Impact of Evidence-Based Medications on Cardiovascular and Cerebrovascular Outcomes in Patients with Acute Coronary Syndrome Post-Revascularization in Oman

et al. 2023

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“…In Iraq, cardiovascular disease is the primary cause of hospitalisations and accounts for 33% of total deaths 2,3. Acute coronary syndrome (ACS) is an umbrella term referring to any group of clinical signs and symptoms consistent with acute myocardial ischemia 4. ACS includes unstable angina, non–ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI), all of which are life-threatening events and major causes of hospitalisations, rising healthcare costs, morbidity, and mortality 5,6…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, the literature indicates that secondary prevention medications are inconsistently prescribed, commonly at suboptimal doses, and poorly adhered to by patients 4,10,11,15,16. Statins can be initiated at optimal doses, while ACE/ARBs and beta-blockers need to be titrated to the optimal dose 11.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of discharge prescriptions for secondary prevention in patients with acute coronary syndromes in Iraq

Nassr

Forsyth

Johnson

2019

Pharm Pract (Granada)

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Background: Optimal prescribing of secondary prevention medications after acute coronary syndrome (ACS) events has been shown to reduce morbidity and mortality. However, it is unknown whether these medications are optimally prescribed at discharge from acute care in Iraq. Objective: To evaluate whether patients with ACS received optimal secondary prevention medications: antiplatelets, statins, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARBs), and beta-blockers at discharge from a cardiology unit, and to assess whether statins, ACEI/ARBs and beta-blockers were prescribed at target doses based on the American Heart Association/American College of Cardiology (AHA/ACC) guidelines. Methods: Observational retrospective cross-sectional study of patients with ACS admitted to a hospital in Baghdad and survived to discharge between May 2016 and January 2017. Patient-level data and secondary prevention medications at discharge were extracted from routine medical records. Optimal dosing was defined as ≥75%, moderate dosing as 50–74%, and low dosing as <50% of the target dose. Results: 45.6% (200/439) of eligible patients were included in the study who were aged 25 to 90 years (mean 57.8 years) with 78.0% (156/200) being male. Of those included, 84.5% had a myocardial infarction and 15.5% unstable angina, and the length of hospital stay ranged from 1 to 29 days (median 4 days). In total, 53.5% of patients were prescribed all five secondary prevention medications at discharge, and after accounting for contraindications, 60.0% were treated according to AHA/ACC guidelines. The prescription rate of dual antiplatelet therapy, statins, ACEI/ARBs and beta-blockers was 92.5%, 94.5%, 69.5% and 87.0% respectively. Hypertension, diabetes mellitus and the prescription of oral nitrates were associated with the prescription of optimal secondary prevention therapy. Although 80.9% of patients were prescribed target doses of antiplatelets and statins, only 12.2% and 9.2% were prescribed target doses of ACEI/ARBs, and beta-blockers respectively. Conclusions: Approximately one in two patients received the recommended secondary prevention therapy. However, only a minority of patients were prescribed optimal doses of ACEI/ARBs and beta-blockers, in line with guidance. Quality improvement strategies should be implemented, which may include greater involvement of pharmacists within the cardiology multidisciplinary team.

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“…Furthermore, the use of guideline-directed medical therapy declined with time. 66) Given that the use of guideline-directed medications has been shown to be inversely associated with mortality, 60) the authors recommend that attention be given to improving prescribing rates of these medications where not contraindicated, as well as to ensuring that patients remain compliant to medical therapy at follow-up.…”

Section: In-hospital Carementioning

confidence: 99%

Identifying and Solving Gaps in Pre- and In-Hospital Acute Myocardial Infarction Care in Asia-Pacific Countries

Tern,

Vaswani,

Yeo

2023

Korean Circ J

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Author's summary Acute myocardial infarction (AMI) morbidity and mortality differs between Asia-Pacific countries and is contributed to by differences in systems of care. This article elaborates on how systems of care can be improved. Suggestions include: 1) Patient education on AMI symptoms and need to activate emergency medical services (EMS); 2) Developing robust, centralized and well-coordinated EMS; 3) Performing pre-hospital electrocardiogram with onward transmission and video telemedicine triage; 4) Setting up geographically oriented ST elevation myocardial infarction networks; 5) Employing algorithms to diagnose high-risk AMI; 6) Adhering to clinical practice guidelines and integrated care pathways; 7) Creating AMI registries and auditing outcomes.

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Optimal medical therapy for secondary prevention after an acute coronary syndrome: 18-month follow-up results at a tertiary teaching hospital in South Korea

Cited by 7 publications

References 40 publications

The Prevalence and Impact of Evidence-Based Medications on Cardiovascular and Cerebrovascular Outcomes in Patients with Acute Coronary Syndrome Post-Revascularization in Oman

The Prevalence and Impact of Evidence-Based Medications on Cardiovascular and Cerebrovascular Outcomes in Patients with Acute Coronary Syndrome Post-Revascularization in Oman

Evaluation of discharge prescriptions for secondary prevention in patients with acute coronary syndromes in Iraq

Identifying and Solving Gaps in Pre- and In-Hospital Acute Myocardial Infarction Care in Asia-Pacific Countries

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