Use of ≥75% of indicated secondary prevention medications after acute coronary syndrome was associated with lower 2-year rates of death or MACE compared to <75% use (8.3% vs 13.9%; OR 0.75).
Observational (n=6,859)
Yes
Does adherence to ≥75% of indicated secondary prevention medications and cardiac rehabilitation reduce death and MACE in patients with acute coronary syndrome?
Adherence to secondary prevention medications and cardiac rehabilitation following ACS significantly reduces the risk of death and MACE at 2 years, though adherence declines over time.
Odds Ratio: 0.75 (95% CI 0.56–0.99)
Absolute Event Rate: 8.3% vs 13.9%
OBJECTIVE: To ascertain the use of secondary prevention medications and cardiac rehabilitation after an acute coronary syndrome (ACS) and the impact on 2-year outcomes. METHODS: CONCORDANCE (Cooperative National Registry of Acute Coronary care, Guideline Adherence and Clinical Events) is a prospective, observational registry of 41 Australian hospitals. A representative sample of 6859 patients with an ACS and 6 months' follow-up on 31 May 2016 were included. The main outcome measure was use of ≥75% of indicated medications (≥4/5 (or ≥3/4 if contraindicated) of angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker, beta-blocker, lipid-lowering therapy, aspirin and other antiplatelet). Major adverse cardiovascular events (MACE) included myocardial infarction, stroke or cardiovascular death. RESULTS: The mean age was 65±13 years, 29% were women, and the mean Global Registry of Acute Coronary Events (GRACE) score was 106±30. At discharge, 92% were on aspirin, 93% lipid-lowering therapy, 78% beta-blocker, 74% ACE/angiotensin receptor blocker and 73% a second antiplatelet; 89% were taking ≥75% of medications at discharge, 78% at 6 months and 66% at 2 years. At 6 months, 38% attended cardiac rehabilitation, 58% received dietary advice and 32% of smokers reported quitting. Among 1896 patients followed to 2 years, death/MACE was less frequent among patients on ≥75% vs <75% of medications (8.3% vs 13.9%; adjusted OR 0.75, 95 % CI 0.56 to 0.99), and was less frequent in patients who attended versus who did not attend cardiac rehabilitation (4.6% vs 13.4%; adjusted OR 0.44, 95% CI 0.31 to 0.62). CONCLUSIONS: Use of secondary prevention therapies diminishes over time following an ACS. Patients receiving secondary prevention had decreased rates of death and MACE at 2 years.
Chow et al. (2019) conducted an observational in Acute coronary syndrome (n=6,859). ≥75% of indicated secondary prevention medications vs. <75% of indicated secondary prevention medications was evaluated on Death or major adverse cardiovascular events (myocardial infarction, stroke or cardiovascular death) (adjusted OR 0.75, 95% CI 0.56 to 0.99). Use of ≥75% of indicated secondary prevention medications after acute coronary syndrome was associated with lower 2-year rates of death or MACE compared to <75% use (8.3% vs 13.9%; OR 0.75).