Only 49% of patients with acute coronary syndrome initiated guideline-recommended ADP receptor-inhibiting oral antiplatelet treatment after hospital discharge, with lower rates in women (OR 0.8; p<0.001).
Cohort (n=54,416)
Yes
What clinical factors are associated with the initiation of and persistence with ADP receptor-inhibiting oral antiplatelet treatment after acute coronary syndrome?
Only half of ACS patients in this nationwide Finnish cohort received guideline-recommended ADP receptor-inhibiting oral antiplatelet therapy, highlighting significant undertreatment in high-risk subgroups such as women, the elderly, and those with comorbidities.
OBJECTIVES: To study patient selection for and persistence with ADP receptor-inhibiting oral antiplatelet (OAP) treatment after acute coronary syndrome (ACS). DESIGN: Observational, retrospective, cohort study linking real-life patient-level register data. SETTING: Nationwide drug usage study using data of patients with ACS discharged from hospitals in Finland. PARTICIPANTS: The study population consisted of 54 416 patients (aged ≥18 years) following hospital admission for unstable angina pectoris or myocardial infarction during 2009-2013. Patients were classified as either OAP or non-OAP users based on drug purchases within 7 days of discharge. OUTCOME MEASURES: Initiation of and a 12-month persistence with OAP medication. RESULTS: In total, 49% of patients with ACS received OAP treatment after hospital discharge. Women represented 40% of the population, but only 32% of them became OAP users (adjusted OR for initiation compared with men 0.8; p38% and p20 percentage points for each). CONCLUSIONS: Only half of the patients with ACS received guideline-recommended ADP receptor-inhibiting OAP treatment after hospital discharge, suggesting suboptimal treatment practices. Non-PCI-treated patients and patients with increased age, unstable angina, dementia or atrial fibrillation appear to have the highest risk of deficient treatment with OAPs. OAP users, however, showed good compliance during drug usage.
Prami et al. (Tue,) conducted a cohort in Acute coronary syndrome (n=54,416). ADP receptor-inhibiting oral antiplatelet (OAP) treatment vs. No OAP treatment was evaluated on Initiation of and a 12-month persistence with OAP medication. Only 49% of patients with acute coronary syndrome initiated guideline-recommended ADP receptor-inhibiting oral antiplatelet treatment after hospital discharge, with lower rates in women (OR 0.8; p<0.001).
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