Why the study?
Medical discharge management of ACS remains suboptimal outside randomized trials and is an essential quality benchmark for ACS care.
Observational (n=1,000)
Yes
A regional Dutch registry demonstrates high but suboptimal adherence to guideline-directed medical therapy after ACS, with 65% of patients receiving all five recommended drug classes at discharge.
Answers are grounded in this paper and cite their sources.
Suboptimal post-ACS discharge prescribing may affect outcomes; leaves open whether quality initiatives improve adherence and prognosis.
BACKGROUND: Medical discharge management of acute coronary syndromes (ACS) remains suboptimal outside randomised trials and constitutes an essential quality benchmark for ACS. We sought to evaluate the rates of key guideline-recommended pharmacological agents after ACS and characteristics associated with optimal treatment at discharge. METHODS: The Rijnmond Collective Cardiology Research (CCR) registry is an ongoing prospective, observational study in the Netherlands that aims to enrol 4000 patients with ACS. We examined discharge and 1-month follow-up medication use among the first 1000 patients enrolled in the CCR registry. Logistic regression was performed to identify patient and hospital characteristics associated with collective guideline-recommended pharmacotherapy at hospital discharge. RESULTS: At discharge, 94 % of patients received aspirin, 100 % thienopyridines, 80 % angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers, 87 % β-blockers, 96 % statins, and 65 % the combination of all 5 agents. ST-segment elevation myocardial infarction, hypertension, hypercholesterolaemia, and enrolment in an interventional centre were positive independent predictors of 5-drug combination therapy at discharge. Negative independent predictors were unstable angina and advanced age. CONCLUSION: Current data from the CCR registry reflect a high quality of care for ACS discharge management in the Rotterdam-Rijnmond region. However, potential still remains for further optimisation.
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Yetgin et al. (2013) conducted an observational in Acute coronary syndromes (n=1,000). Guideline-recommended 5-drug combination therapy was evaluated on Collective discharge prescription of aspirin, thienopyridines, ACE-I/ARBs, β-blockers, and statins.
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