An up-titration plan in discharge communication for patients with acute coronary syndromes was not associated with subsequent dose optimization of high-intensity statins at 90 days (p=0.26).
Cohort (n=89)
No
Does discharge communication regarding up-titration improve 30- and 90-day GDMT retention and optimization in patients following acute coronary syndromes?
Despite high GDMT prescribing rates at discharge following ACS, early post-discharge retention declines and dose escalation is low, with discharge communication alone failing to improve subsequent optimization.
p-value: p = 0.26
Abstract Background Guideline-directed medical therapy (GDMT) following acute coronary syndromes (ACS) reduces mortality, recurrent events and improves long-term outcomes. Beyond initiation, GDMTs should be progressively up-titrated to the maximum tolerated dose for full therapeutic benefits. Although efforts have focused on optimising prescribing before discharge, less is known about the GDMT retention and optimisation in the early post-discharge phase. Evaluating real-world patterns at 30 and 90 days is therefore critical to identify gaps in secondary prevention and strengthen transition-of-care pathways to primary care and community clinicians. Purpose This study aims to assess 30- and 90-day GDMT retention and optimisation following ACS, and to evaluate the impact of discharge communication on subsequent up-titration. Methods We conducted a prospective study of adults admitted with ACS and discharged with confirmed unstable angina or myocardial infarction between August and December 2024. Patients who died during admission or follow-up or underwent inpatient cardiac surgery were excluded. Demographics, prescriptions, and discharge communication data were collected from hospital and primary care records for lipid lowering therapies (LLT), renin–angiotensin–aldosterone system inhibitors (RAASi), and beta-blockers. Retention and up-titration were assessed at 30 and 90 days compared to discharge. Statistical analysis was performed using Fisher’s exact test, with significance set at p 0.05. Results Eighty-nine patients were included (60 males; median age 70 ± 13.2 years). Among eligible patients, discharge prescribing rates were 94.2% for high-intensity statins (HiS), 96.1% for RAASi, and 97.3% for beta-blockers. Retention remained high for HiS (95% at 30 days; 91% at 90 days) and beta-blockers (100% at 30 days; 97% at 90 days) but declined markedly for RAASi (95% at 30 days; 75% at 90 days). Dose optimisation was limited: only 4.1% and 9.6% of patients underwent RAASi up-titration at 30 and 90 days, while beta-blockers were up-titrated in 8.3% and 9.7%, respectively. Lipid monitoring was suboptimal, with only 40.2% undergoing LDL-C testing at 90 days and LLT escalation occurring in just 3.4% of patients. Over half of GDMT discharge prescriptions included communication regarding optimisation; however, inclusion of an up-titration plan was not associated with subsequent optimisation at follow-up for HiS (p = 0.26 at 90 days), RAASi (p = 0.60 at 30 days; p = 0.69 at 90 days) or beta-blockers (p = 0.20 at 30 days; p = 1.00 at 90 days). Conclusions Despite achieving substantial GDMT optimisation at discharge, variable retention trajectories and low rates of dose escalation were observed. The absence of an association between communication and subsequent optimisation highlights the need for a multifaceted and systematic approach to maintain therapeutic momentum beyond discharge and improve long-term cardiovascular outcomes.
Iordanescu et al. (Mon,) conducted a cohort in Acute coronary syndromes (n=89). Discharge communication with an up-titration plan vs. No up-titration plan in discharge communication was evaluated on Subsequent dose optimisation of guideline-directed medical therapy at follow-up (p=p = 0.26). An up-titration plan in discharge communication for patients with acute coronary syndromes was not associated with subsequent dose optimization of high-intensity statins at 90 days (p=0.26).