Differences in the use of guideline-recommended therapies among 14 European countries in patients with acute coronary syndromes undergoing PCI

Zeymer, Uwe; James, Stefan; Berkenboom, Guy; Mohácsi, Attila; Íñiguez, Andrés; Coufal, Zdeněk; Sartral, Magali; Paget, M; Norrbacka, Kirsi; Ferrières, Jean; Bakhai, Ameet

doi:10.1177/2047487312437060

Cited by 28 publications

(18 citation statements)

References 20 publications

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“…While all registries are unique, with subtle differences, our results compare favorably to other established international cohorts. We note that the MIG registry has higher 12‐month rates of statin use (93% vs. 87%) and aspirin use (96% vs. 87%) and lower rates of BB use (70% vs. 81%) compared with the European APTOR registry . The EUROASPIRE III survey analyzed a cohort of patients presenting with myocardial infarction, revascularized with PCI or cardiac bypass surgery.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Medication Use Following Percutaneous Coronary Intervention: The Australian Experience

Cole

Brennan

Ajani

et al. 2014

Cardiovascular Therapeutics

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SUMMARYAims: Despite the guidelines, a "treatment gap" exists in the delivery of pharmacotherapy for secondary prevention. We aimed to analyze the trend in guideline-based medication usage following percutaneous coronary intervention (PCI) using the Melbourne Interventional Group (MIG) registry over a 6-year period (2005)(2006)(2007)(2008)(2009)(2010). Methods: The MIG registry prospectively collects demographical, clinical, and procedural characteristics of consecutive patients undergoing PCI. We assessed medication use (aspirin, clopidogrel, ACE inhibitors, angiotensin receptor blockers, beta-blockers, and lipid-lowering agents) at 30 days and 12 months in patients alive and able to provide the information. Results: The cohort consists of 12,813 patients who underwent 14,787 consecutive interventional procedures. They comprised 76% males: 22% were elderly (≥75 years), 23% had diabetes, 2% had severe renal impairment, 2% had severe left ventricular dysfunction, 26% presented with STEMI, and 44% of patients received drug-eluting stent. Follow-up was complete for 97.8% of the cohort at 30 days (2.2% mortality) and 89.1% at 12 months (4% mortality). From 2005 to 2010, the percentage of patients taking all five classes of medications increased each year. In 2010 at 30 days, nearly 60% of patients took all five classes of medications, and by 12 months, 75% of patients were taking four or five classes of medications. Conclusion: In conclusion, while the increasing use of cardiovascular medicines in an "at-risk" Australian cohort is encouraging, a treatment gap appears to still exist.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular Medication Use Following Percutaneous Coronary Intervention: The Australian Experience

Cole

Brennan

Ajani

et al. 2014

Cardiovascular Therapeutics

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“…Several studies have investigated the medication use for secondary prevention in patients with coronary heart disease 16 , 17 , 18 . However, the use of guideline-directed medical therapy for secondary prevention medications after CABG in patients with depression has not been thoroughly explored.…”

Section: Discussionmentioning

confidence: 99%

“…The use of guideline-directed medical therapy was studied in European patients with acute coronary syndromes who underwent PCI [17] . Despite common management guidelines [6] , a large variation in the use of guideline-directed medical therapy was found between the different countries.…”

Section: Discussionmentioning

confidence: 99%

Guideline-directed medical therapy for secondary prevention after coronary artery bypass grafting in patients with depression

Stenman

Holzmann

Sartipy

2014

IJC Heart & Vessels

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BackgroundWe hypothesized that depressed patients would have lower use of guideline-directed medical therapy for secondary prevention of cardiovascular events following coronary artery bypass grafting (CABG).MethodsWe included all patients who underwent primary isolated CABG in Sweden between 2006 and 2008. We cross-linked individual level data from national Swedish registers. Preoperative depression was defined as at least one antidepressant prescription dispensed before surgery. We defined medication use as at least two dispensed prescriptions in each medication class (antiplatelet agents, beta-blockers, angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blocker (ARB), and statins) within a rolling 12 month period. We calculated adjusted risk ratios (RR) for the use of each medication class, and for all four classes, after one and four years, respectively.ResultsDuring the first year after CABG, 93% of all patients (n = 10,586) had at least two dispensed prescriptions for an antiplatelet agent, 68% for an ACEI/ARB, 91% for a beta-blocker, and 92% for a statin. 57% had prescriptions for all four medication classes. After four years (n = 4034), 44% had filled prescriptions for all four medication classes. Preoperative depression was not significantly associated with a lower use of all four medication classes after one year (RR 0.98, 95% confidence interval (CI) 0.93–1.03) or after four years (RR 0.97, 95% CI 0.86–1.09).ConclusionsPreoperative depression was not associated with lower use of guideline-directed medical therapy for secondary prevention after CABG. These findings suggest that the observed higher mortality following CABG among depressed patients is not explained by inadequate secondary prevention medication.

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“… 3–6 Nevertheless, there is still large variability in the real-world management of patients with ACS, both within and between countries. 7–9 Evidence-based management is often suboptimal, 9 10 and the risk of experiencing a new cardiovascular (CV) event remains high. 11 12 Reasons for variability in healthcare resource use (HCRU) in patients with ACS may be related to differences in availability of catheterisation laboratories and/or cardiac surgery facilities, or patient-related factors, such as insurance coverage, 13 age 14 and sex.…”

Section: Introductionmentioning

confidence: 99%

Prehospital and in-hospital use of healthcare resources in patients surviving acute coronary syndromes: an analysis of the EPICOR registry

et al. 2016

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ObjectiveThe aim of this report is to provide insight into real-world healthcare resource use (HCRU) during the critical management of patients surviving acute coronary syndromes (ACS), using data from EPICOR (long-tErm follow-up of antithrombotic management Patterns In acute CORonary syndrome patients) (NCT01171404).MethodsEPICOR was a prospective, multinational, observational study that enrolled 10 568 ACS survivors from 555 hospitals in 20 countries in Europe and Latin America, between September 2010 and March 2011. HCRU was evaluated in patients with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation ACS (NSTE-ACS), with or without a history of cardiovascular disease (CVD). Multivariable analysis was performed to determine factors that affected resource use.ResultsBefore hospitalisation, more patients with STEMI than with NSTE-ACS had their first ECG (44.1% vs 36.4%, p<0.0001) and received antithrombotic medication (26.6% vs 15.2%, p<0.0001). Patients with NSTE-ACS with prior CVD were less likely than those without to be catheterised (73.1% vs 82.8%, p<0.0001). More patients with STEMI than with NSTE-ACS had percutaneous coronary intervention (77.1% vs 54.9%, p<0.0001), but fewer underwent coronary artery bypass grafting (1.2% vs 3.7%, p<0.0001). Multivariable analysis showed that resource use, including length of hospital stay and coronary revascularisation, was significantly influenced by multiple factors, including ACS type, site characteristics and region (all p≤0.05).ConclusionsIn this large-scale, real-life study, findings were generally in line with clinical logic, although site characteristics and region still significantly affected resource use. Moreover, and unexpectedly, resource use tended to be slightly higher in patients without a history of CVD.Trial registration numberNCT01171404 (ClinicalTrials.gov).

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Differences in the use of guideline-recommended therapies among 14 European countries in patients with acute coronary syndromes undergoing PCI

Cited by 28 publications

References 20 publications

Cardiovascular Medication Use Following Percutaneous Coronary Intervention: The Australian Experience

Cardiovascular Medication Use Following Percutaneous Coronary Intervention: The Australian Experience

Guideline-directed medical therapy for secondary prevention after coronary artery bypass grafting in patients with depression

Prehospital and in-hospital use of healthcare resources in patients surviving acute coronary syndromes: an analysis of the EPICOR registry

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