Impact of combination evidence-based medical therapy on mortality in patients with acute coronary syndromes

Abstract

Background-Several individual pharmacological agents, such as antiplatelet drugs, ␤-blockers, ACE inhibitors, and lipid-lowering agents, have proven efficacy in reducing mortality in patients with acute coronary syndromes. However, the impact of the combination of these agents on clinical outcomes has not been studied before. Methods and Results-A total of 1358 consecutive patients presenting with acute coronary syndromes between January 1999 and March 2002 were identified, and data on baseline demographics, comorbidities, and in-hospital management were collected. On the basis of discharge use of evidence-based therapies, we created a composite appropriateness score depending on the number of the drugs used divided by the number of the drugs potentially indicated for each patient. The impact of the composite score on 6-month mortality was analyzed using a risk-adjusted logistic regression model. The odds ratio for death for all indicated medications used (appropriateness level IV) versus none of the indicated medications used (appropriateness level 0) was 0.

Adherence to Evidence-Based Therapies After Acute Coronary Syndrome: A Retrospective Population-Based Cohort Study Linking Hospital, Outpatient, and Pharmacy Health Information Systems in Valencia, Spain

“…Additionally, these studies usually focus on the rates of appropriate prescriptions, but the extent to which prescribed therapies are maintained over time has received less attention. It should be noted that adherence to a combination of evidence-based medical therapies is strongly associated with lower mortality in patients after an ACS, [14][15][16][17][18] and guidelines recommend these therapies be used indefinitely. 4 At present, most of the information necessary for guiding quality improvement policies in CHD secondary prevention is available in electronic databases that store data from hospital discharge, electronic medical records, physician order entry systems, electronic prescribing systems, and pharmaceutical dispensation records.…”

Doctors and Hospitals

“…Indeed, the link between process of care and clinical outcomes has been established. 14,15 For example, hospitals compliant with American College of Cardiology/American Heart Association guidelines for care of patients with non-ST-segmentelevation acute coronary syndromes demonstrate reduced in-hospital mortality rates when compared with noncompliant hospitals. In an attempt to promote guideline-driven care, the Center for Medicare and Medicaid Services has proposed a pilot program for incremental reimbursement to those hospitals that document the highest degree of guideline compliance.…”

The challenge of improving evidence-based therapy adherence in the secondary prevention of coronary artery disease: the next frontier of cardiac rehabilitation

“…In conseguenza le linee guida raccomandano l'utilizzo routinario di questi farmaci [1][2][3]. Infatti, Goldberg et al [4], usando i dati dello studio GRACE (Global Registy of Acute Coronary Events), su 26.413 pazienti senza controindicazioni alla loro assunzione, hanno rilevato, dopo l'implementazione delle linee guida, un deciso aumento dal 2000 al 2005 nell'assunzione di statine (dal 45% al 85%), ACE-I (dal 63% al 77%), betabloccanti (al 83% al 91%) e ASA (circa 95%).…”

“…Nell'aderenza alla terapia è necessario rilevare anche il dosaggio dei farmaci assunti per il raggiungimento del target, perché solo in questo modo si ottengono benefici [2]. Gli aderenti alla terapia poi sono aderenti spesso anche alle modificazioni dello stile di vita [9].…”