Physicians' adherence to acute coronary syndrome prescribing guidelines in <scp>V</scp>ietnamese hospital practice: a cross‐sectional study

Nguyễn, Thắng; Nguyen, Thao Huong; Pham, Hoa Thi; Nguyen, Thu T A; Huynh, Khoa M.; Vo, Phuong; Pham, Tung Thanh; Taxis, Katja

doi:10.1111/tmi.12467

Cited by 9 publications

(10 citation statements)

References 52 publications

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“…A retrospective cohort study of 202 patients with ACS in China demonstrated that patients were more likely to achieve LDL-C goal if they were receiving ezetimibe plus statin (69.1%, P = 0.007) or intensive statin therapy (67.9%, P = 0.047) compared with moderate-intensity statin (46.9%) [31]. Consistent results were reported for a prospective cohort study in 84 Chinese patients with [109,110] 90.7 [110] 100 [89] ACS acute coronary syndrome a For studies that recorded percentage statin use over more than 1 time period, the data for the most recent time period are presented [34]. Rates of statin use were similar in the three groups at discharge (96-98%) and at 1 year post ACS (93-96%); however, goal attainment rates differed between the groups (P \ 0.001); 23% of patients in whom FH was unlikely achieved their LDL-C goal, compared with 13% and 12% of patients with probable and possible FH, respectively.…”

Section: Use Of High-intensity Lmt Statin Therapysupporting

confidence: 60%

A Narrative Review and Expert Panel Recommendations on Dyslipidaemia Management After Acute Coronary Syndrome in Countries Outside Western Europe and North America

et al. 2020

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Patients who have experienced an acute coronary syndrome (ACS) are at very high risk of recurrent atherosclerotic cardiovascular disease (CVD) events. Dyslipidaemia, a major risk factor for CVD, is poorly controlled post ACS in countries outside Western Europe and North America, despite the availability of effective lipid-modifying therapies (LMTs) and guidelines governing their use. Recent guideline updates recommend that low-density lipoprotein cholesterol (LDL-C), the primary target for dyslipidaemia therapy, be reduced by C 50% and to \ 1.4 mmol/L (55 mg/dL) in patients at very high risk of CVD, including those with ACS. The high prevalence of CVD risk factors in some regions outside Western Europe and North America confers a higher risk of CVD on patients in these countries. ACS onset is often earlier in these patients, and they may be more challenging to treat. Other barriers to effective dyslipidaemia control include low awareness of the value of intensive lipid lowering in patients with ACS, physician non-adherence to guideline recommendations, and lack of efficacy of currently used LMTs. Lack of appropriate pathways to guide follow-up of patients with ACS post discharge and poor access to intensive medications are important factors limiting Digital Features To view digital features for this article go to

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Section: Use Of High-intensity Lmt Statin Therapysupporting

confidence: 60%

A Narrative Review and Expert Panel Recommendations on Dyslipidaemia Management After Acute Coronary Syndrome in Countries Outside Western Europe and North America

et al. 2020

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“…Thirdly, we could not assess conditions that contraindicated the use of DAPT, anticoagulants, and statins, such as history of intolerance, active gastrointestinal bleeding, or active liver disease [20,[43][44][45][46]. The prevalence of conditions that contraindicated the use of these medications in STEMI patients has also rarely been reported in previous studies.…”

Section: Limitationsmentioning

confidence: 94%

Association between Adherence to Guideline-Recommended Preventive Medications and In-Hospital Mortality among Non-Reperfused ST-Elevation Myocardial Infarction Patients Admitted to a Tertiary Care Academic Center in a Developing Country

Irawati

Dharma

Taxis

et al. 2020

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Background and aims: Acute ST-elevation myocardial infarction (STEMI) is a potentially fatal presentation of coronary artery disease (CAD). Evidence of the impact of acute pharmacological interventions in non-reperfused STEMI patients on subsequent events is limited. We aimed to assess the association between adherence to guideline-recommended preventive medications and in-hospital mortality among this high-risk patient population. Methods: We conducted a cohort study using data obtained from the Jakarta Acute Coronary Syndrome (JAC) Registry database from a tertiary care academic hospital in Indonesia. We included 1132 of 2694 patients with STEMI recorded between 1 January 2014 and 31 December 2016 who did not undergo acute reperfusion therapy. Adherence to guidelinerecommended preventive medications was defined as the combined administration of aspirin, clopidogrel, anticoagulants and statins after hospital admission. The main outcome measure was in-hospital mortality. Results: Overall, 778 of 1132 patients (69%) received the combination of preventive medications. The guideline non-adherent group had significantly more patients with earlier onset of STEMI, higher Killip class and thrombolysis in myocardial infarction (TIMI) score. After adjustments for measured characteristics using logistic regression modeling, exposure to the combination of preventive therapies was associated with a statistically significant lower risk for in-hospital mortality (adjusted odds ratio: 0.46, 95% confidence interval: 0.30-0.70). Conclusions: Adherence to guideline-recommended preventive medications was associated with lower risk of in-hospital mortality in non-reperfused STEMI patients. The predictors of not receiving these medications need to be confirmed in future research.

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“…We have described the criteria to be eligible for being prescribed the medications elsewhere. 17 Briefly, patients eligible for being prescribed an antiplatelet agent, a beta-blocker or a statin were all patients who did not have contraindications to the medications. Patients eligible for being prescribed an ACEI/ARB were patients with prior heart failure, an LVEF<40%, diabetes mellitus or hypertension, and no contraindications to the medication.…”

Section: Methodsmentioning

confidence: 99%

“… 14–16 In fact, in-hospital guideline adherence for patients with ACS in Vietnam was suboptimal. 17 Prescribing of guideline-recommended medications has been shown to reduce both in-hospital and postdischarge morbidity and mortality. 18–22 The impact of guideline adherence on mortality of patients with ACS during hospitalisation has been determined previously.…”

Section: Introductionmentioning

confidence: 99%

Association between in-hospital guideline adherence and postdischarge major adverse outcomes of patients with acute coronary syndrome in Vietnam: a prospective cohort study

Nguyễn

Cao

et al. 2017

BMJ Open

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ObjectiveWe aimed to determine the association between physician adherence to prescribing guideline-recommended medications during hospitalisation and 6-month major adverse outcomes of patients with acute coronary syndrome in Vietnam.DesignProspective cohort study.SettingThe study was carried out in two public hospitals in Vietnam between January and October 2015. Patients were followed for 6 months after discharge.ParticipantsPatients who survived during hospitalisation with a discharge diagnosis of acute coronary syndrome and who were eligible for receiving at least one of the four guideline-recommended medications.ExposuresGuideline adherence was defined as prescribing all guideline-recommended medications at both hospital admission and discharge for eligible patients. Medications were antiplatelet agents, beta-blockers, ACE inhibitors or angiotensin II receptor blockers and statins.Main outcome measureSix-month major adverse outcomes were defined as all-cause mortality or hospital readmission due to cardiovascular causes occurring during 6 months after discharge. Cox regression models were used to estimate the association between guideline adherence and 6-month major adverse outcomes.ResultsOverall, 512 patients were included. Of those, there were 242 patients (47.3%) in the guideline adherence group and 270 patients (52.3%) in the non-adherence group. The rate of 6-month major adverse outcomes was 30.5%. A 29% reduction in major adverse outcomes at 6 months after discharge was found for patients of the guideline adherence group compared with the non-adherence group (adjusted HR, 0.71; 95% CI, 0.51 to 0.98; p=0.039). Covariates significantly associated with the major adverse outcomes were percutaneous coronary intervention, prior heart failure and renal insufficiency.ConclusionsIn-hospital guideline adherence was associated with a significant decrease in major adverse outcomes up to 6 months after discharge. It supports the need for improving adherence to guidelines in hospital practice in low-income and middle-income countries like Vietnam.

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Physicians' adherence to acute coronary syndrome prescribing guidelines in Vietnamese hospital practice: a cross‐sectional study

Abstract: In general, physicians closely adhered to ACS prescribing guidelines in Vietnamese hospital practice. Prescribing of beta blockers and clopidogrel loading doses was probably suboptimal. Why patients do not complete treatment needs to be investigated.

Cited by 9 publications

References 52 publications

A Narrative Review and Expert Panel Recommendations on Dyslipidaemia Management After Acute Coronary Syndrome in Countries Outside Western Europe and North America

A Narrative Review and Expert Panel Recommendations on Dyslipidaemia Management After Acute Coronary Syndrome in Countries Outside Western Europe and North America

Association between Adherence to Guideline-Recommended Preventive Medications and In-Hospital Mortality among Non-Reperfused ST-Elevation Myocardial Infarction Patients Admitted to a Tertiary Care Academic Center in a Developing Country

Association between in-hospital guideline adherence and postdischarge major adverse outcomes of patients with acute coronary syndrome in Vietnam: a prospective cohort study

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