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Frequency and determinant factors of adherence to current guidelines of clinical practice regarding pharmacological treatment prescribed at discharge after acute coronary syndrome

Session Moderated Poster Session 3 - Acute Coronary Syndromes II

Speaker Bertold Gunnar Leithold

Congress : Acute Cardiovascular Care 2018

  • Sub-topic : Acute Coronary Syndromes: Pharmacotherapy Treatment
  • Session type : Moderated Posters
  • FP Number : 96

Authors : G Leithold (Murcia,ES), MJ Sanchez Galian (Murcia,ES), AA Lopez Cuenca (Murcia,ES), E Guerrero Perez (Murcia,ES), PJ Flores Blanco (Murcia,ES), P Ramos Ruiz (Cartagena,ES), DJ Vazquez Andres (Murcia,ES), E Pinar Bermudez (Murcia,ES), JR Gimeno Blanes (Murcia,ES), S Manzano Fernandez (Murcia,ES)

Authors:
G Leithold1 , MJ Sanchez Galian1 , AA Lopez Cuenca2 , E Guerrero Perez1 , PJ Flores Blanco1 , P Ramos Ruiz3 , DJ Vazquez Andres1 , E Pinar Bermudez1 , JR Gimeno Blanes1 , S Manzano Fernandez1 , 1University Hospital Virgen De La Arrixaca - Murcia - Spain , 2University Hospital Morales Meseguer, Cardiology - Murcia - Spain , 3University Hospital de Santa Lucía, Cardiology - Cartagena - Spain ,

Citation:
European Heart Journal Supplement ( 2018 ) 7 ( Supplement ), S29

Background: The prognostic importance of an adequate adherence to clinical practice guidelines is well known.
Purpose: The aim of this study was to evaluate the degree of adherence to current guidelines in a regional cohort of patients admitted for acute coronary syndrome (ACS).
Methods: In this prospective cohort study 1625 consecutive patients between January 2011 and September 2015 admitted for ACS to 4 regional hospitals in southern Spain were included. Optimal pharmacological treatment at discharge was defined as the combination of dual antiplatelet therapy, angiotensin-converting enzyme (ACE) inhibitors or Angiotensin II receptor antagonists (ARBs), high dose statins (Atorvastatin 80 mg or Rosuvastatin 20 mg) and Beta blockers.
Results: At discharge, 92.99% of the population had been prescribed dual antiplatelet therapy; 92.8% received Beta blockers; 93.73% ACE inhibitors or ARBs and 61.78% high dose statins. Globally, 834 patients (51.32%) had been prescribed optimal treatment at discharge. Analysed in terms of the number of recommended drugs, 8 patients (0.49%) were discharged without any drug, 42 patients (2.58%) with one agent, 154 patients (9.48%) with two, 587 patients (36.12%) with three and 834 patients (51.32%) with four (optimal treatment). Multivariate logistic regression analysis identified as predictors of optimal treatment at discharge haemoglobin level at admission, history of arterial hypertension, renal function, history of atrial fibrillation or flutter, year of admission and percutaneous coronary intervention.
Conclusion: In the present study, only slightly more than half of the patients discharged after ACS were prescribed optimal pharmacological therapy recommended by current clinical practice guidelines with the inherent prognostic impact that might entail. Multiple factors have been identified as predictors of not achieving optimal treatment. Thus it is of utmost importance to continue the work of the scientific societies promulgating optimal treatment strategies at discharge in patients with ACS.

OR (CI 95%) p
GRACE 6 months (per 10 points) 10.10 (10.00-10.20) 0.028
Haemoglobin 1.12 (1.04-1.21) 0.002
eGFR (CKD-EPI) [ml/min/1.73m2] 1.01 (1.00-1.03) <0.001
Hypertension 1.65 (1.26-2.18) <0.001
History of atrial fibrillation or flutter 0.43 (0.32-0.61) <0.001
Year of admission 1.01 (1.00-1.01) <0.001
Percutaneous coronary intervention 2.69 (2.05-3.54) <0.001

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