Adherence to guidelines for the prescription of secondary prevention medication at hospital discharge after acute coronary syndrome: a multicentre study

Abstract

BackgroundThe prescription of guideline-recommended medication for secondary prevention after acute coronary syndrome has been suboptimal in the past. In the present study, guideline adherence and associated patient, care and hospital characteristics at hospital discharge after acute coronary syndrome were studied.MethodsCharts of patients with acute coronary syndrome discharged from 13 Dutch hospitals in 2012 were reviewed. Guideline adherence was defined as the prescription of acetylsalicylic acid, P2Y12 receptor inhibitor, statin, beta-blocker and angiotensin-converting enzyme (ACE) inhibitor at discharge, or a documented contraindication. Associated characteristics were identified by means of generalized linear mixed models for binary outcomes.ResultsIn total, 2471 patients were included. Complete guideline adherence was achieved in 69.1 % of the patients, ranging from 42.1 to 87.0 % between hospitals. The ACE inhibitor was most often missing (21.2 %). Patients with non-ST-segment elevation myocardial infarction or unstable angina, patients with a history of coronary artery bypass grafting or elderly women were less likely to be discharged with the guideline-recommended medication.ConclusionsGuideline adherence for secondary prevention medication following acute coronary syndrome was substantial; however, variation between hospitals and patient groups was found. Efforts to increase guideline adherence can focus on underperforming hospitals and undertreated patient groups.

Nationwide claims data validated for quality assessments in acute myocardial infarction in the Netherlands

“…Previous studies focussing on medication at discharge show a substantial guideline adherence in patients with AMI (65–69% were prescribed all five indicated drugs) [ 25 , 26 ]. Additionally, a recent European guideline evaluation by the EUROASPIRE IV Study Group showed comparable secondary prevention rates at a median follow-up time of 16 months after myocardial infarction: 94% antiplatelets, 86% statins, 83% beta-blockers and 75% ACE inhibitors/AT2 antagonists [ 27 ].…”

Optimal medical therapy for secondary prevention after an acute coronary syndrome: 18-month follow-up results at a tertiary teaching hospital in South Korea

“…According to the studies conducted in the Netherlands, about 65% and 69% of ACS patients were discharged with the guideline-recommended medications for ACS secondary prevention. 20 , 23 The study conducted in Australia and New Zealand also reported that the rate of ACS patients discharged on secondary prevention medications was about 71%. 26 However, this study applied the different definition about an optimal medication therapy for secondary prevention after ACS.…”

Rationale and Design of the Future Optimal Research and Care Evaluation in Patients with Acute Coronary Syndrome (FORCE-ACS) Registry: Towards “Personalized Medicine” in Daily Clinical Practice

“…Medical knowledge is advancing at an ever-increasing rate, and clinicians face the challenge of keeping up with all these new advancements. Excessive demands can lead to suboptimal guideline adherence and variation among hospitals [ 25 ]. Clinical decision support systems can help clinicians decide on optimal therapies for their patients on a more personalized basis, incorporating clinical parameters and even genetic data.…”