Geographic region was significantly associated with the use of every class of evidence-based medication early after acute coronary syndromes among 15,904 patients across 37 countries.
Observational (n=15,904)
Yes
There is significant international variation in the early use of evidence-based medications for acute coronary syndromes, with region, age, and specific diagnosis influencing prescribing patterns.
AIMS: We sought to evaluate international patterns of use and factors influencing use of evidence-based medications early after ACS. METHODS AND RESULTS: Using a database of 15904 ACS patients enrolled in the SYMPHONY and 2nd SYMPHONY trials in 37 countries, we performed descriptive and logistic regression analyses. After controlling for other factors, region was significantly associated with the use of every class of evidence-based medication, most pronounced for intravenous unfractionated heparin (IV UFH), low-molecular-weight heparin (LMWH), angiotensin II converting enzyme inhibitors (ACEI) and discharge use of lipid-lowering agents. Latin America and Eastern Europe were among the highest users of early ACEI, yet the lowest users of discharge lipid-lowering therapy. Relative to the United States, all regions except Canada had greater use of LMWH and lower use of IV UFH. Compared with patients with acute myocardial infarction, those with unstable angina less often received aspirin, beta-blockers, ACEI, or IV UFH. Older age was associated with lower use of aspirin, beta-blockers, IV UFH, and lipid-lowering agents. CONCLUSIONS: Use of evidence-based therapies for management of ACS patients is strongly associated with region. To improve patient outcomes, more research is needed to understand this variation, and to institute appropriate solutions.
John R. Kramer (Mon,) conducted a observational in Acute coronary syndromes (n=15,904). Evidence-based medications was evaluated on Use of evidence-based medications early after ACS. Geographic region was significantly associated with the use of every class of evidence-based medication early after acute coronary syndromes among 15,904 patients across 37 countries.