Preventing recurrent events long term after coronary artery bypass graft: suboptimal use of medications in a population study

Bradshaw, Pamela J.; Jamrozik, Konrad; Gilfillan, Ian; Thompson, Peter L.

doi:10.1016/j.ahj.2003.07.028

Cited by 33 publications

(16 citation statements)

References 29 publications

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“…[8][9][10] However, limited published literature suggests that the use of medication for secondary prevention remains suboptimal after coronary revascularization, particularly after CABG. [11][12][13][14][15][16] This underuse of OMT might reflect medication nonadherence or issues with the healthcare system or may be related to a paucity of data, leading to an underestimation of importance of OMT and the misconception that continuing OMT may be of less value once diseased coronary arteries have been mechanically revascularized. 17,18 Recent controversies on the use of β-blockers, generally and in noncardiac surgery, and statins may further reduce prescription or compliance, [19][20][21][22] with potential consequences on long-term clinical outcomes.…”

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confidence: 99%

Optimal Medical Therapy Improves Clinical Outcomes in Patients Undergoing Revascularization With Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting

et al. 2015

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Background-There is a paucity of data on the use of optimal medical therapy (OMT) in patients with complex coronary artery disease undergoing revascularization with percutaneous coronary intervention or coronary artery bypass grafting (CABG) and its long-term prognostic significance. Methods and Results-The Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial is a multicenter, randomized, clinical trial of patients (n=1800) with complex coronary disease randomized to revascularization with percutaneous coronary intervention or CABG. Detailed drug history was collected for all patients at discharge and at the 1-month, 6-month, 1-year, 3-year, and 5-year follow-ups. OMT was defined as the combination of at least 1 antiplatelet drug, statin, β-blocker, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. Five-year clinical outcomes were stratified by OMT and non-OMT. OMT was underused in patients treated with coronary revascularization, especially CABG. OMT was an independent predictor of survival. OMT was associated with a significant reduction in mortality (hazard ratio, 0.64; 95% confidence interval, 0.48-0.85; P=0.002) and composite end point of death/myocardial infarction/stroke (hazard ratio, 0.73; 95% confidence interval, 0.58-0.92; P=0.007) at the 5-year follow-up. The treatment effect with OMT (36% relative reduction in mortality over 5 years) was greater than the treatment effect of revascularization strategy (26% relative reduction in mortality with CABG versus percutaneous coronary intervention over 5 years). On stratified analysis, all the components of OMT were important for reducing adverse outcomes regardless of revascularization strategy. Conclusions-The use of OMT remains low in patients with complex coronary disease requiring coronary intervention with percutaneous coronary intervention and even lower in patients treated with CABG. Lack of OMT is associated with adverse clinical outcomes. Targeted strategies to improve OMT use in postrevascularization patients are warranted. Clinical Trial Registration-URL: http://www.clinicaltrials.gov.

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Optimal Medical Therapy Improves Clinical Outcomes in Patients Undergoing Revascularization With Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting

et al. 2015

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“…Nonostante i dimostrati benefici la terapia cardioprotettiva però è poco utilizzata per la scarsa aderenza dei pazienti: infatti il 20-50% risulta non aderente alla terapia medica cronica [5][6].…”

Section: Introduzioneunclassified

“…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%).Nonostante i dimostrati benefici la terapia cardioprotettiva però è poco utilizzata per la scarsa aderenza dei pazienti: infatti il 20-50% risulta non aderente alla terapia medica cronica [5][6].L'aderenza alla terapia è la percentuale di farmaci e delle loro dosi, prescritte dai medici curanti, che i pazienti devono assumere con la stabilita frequenza e per un preciso periodo di tempo. A differenza della compliance (grado con cui il comportamento passivo di un paziente coincide con le raccomandazioni del medico), l'aderenza prevede il coinvolgimento attivo e collaborativo del paziente a cui si chiede di partecipare alla pianificazione e all'attuazione di un trattamento elaborando un consenso basato sull'accordo [7].…”

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

Scardi

Mazzone²,

Umari

2016

Monaldi Arch Chest Dis

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EDITORIALE IntroduzioneMolti studi randomizzati e controllati hanno definitivamente dimostrato l'efficacia dell'uso di acido acetilsalicilico (ASA), betabloccanti, ACE-inibitori (ACE-I) e statine per la prevenzione secondaria nei pazienti con cardiopatia ischemica. 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%).Nonostante i dimostrati benefici la terapia cardioprotettiva però è poco utilizzata per la scarsa aderenza dei pazienti: infatti il 20-50% risulta non aderente alla terapia medica cronica [5][6].L'aderenza alla terapia è la percentuale di farmaci e delle loro dosi, prescritte dai medici curanti, che i pazienti devono assumere con la stabilita frequenza e per un preciso periodo di tempo. A differenza della compliance (grado con cui il comportamento passivo di un paziente coincide con le raccomandazioni del medico), l'aderenza prevede il coinvolgimento attivo e collaborativo del paziente a cui si chiede di partecipare alla pianificazione e all'attuazione di un trattamento elaborando un consenso basato sull'accordo [7].L'aderenza è un fenomeno complesso che riflette l'interfaccia tra efficacia, tollerabilità, frequenza di somministrazione, interazioni fra preparati, effetti indesiderati e costi di eventuali tickets [8]. 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].La prevenzione secondaria della cardiopatia ischemica è difficile a causa della politerapia (almeno 3-4 farmaci al giorno) che comporta regimi complessi con prescrizioni multiple e pluralità di somministrazioni in ore differenti della giornata. Ciò Migliorare l'aderenza all'assunzione dei farmaci per la prevenzione secondaria della cardiopatia ischemica: la prossima frontiera della riabilitazione cardiovascolare ABSTRACT:The challenge of improving evidence-based therapy adherence in the secondary prevention of coronary artery disease: the next frontier of cardiac rehabilitation. S. Scardi, C. Mazzone, P. Umari. Non-adherence to prescribed drug regimens is an increasing medical problem affecting physicians and patients and contribute to negative outcomes, such as the increased risk of subsequent cardiovascular events. Analysis of various patient populations shows that the choice of drug, its tolerability and the duration of treatment influence the non-adherence. Intervention is required toward patients and health-care providers to improve medication adherence. This review deals about the prevalence of n...

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“…115 Researchers have found that older patients are less likely to receive appropriate antihypertensive drugs, aspirin, and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors after coronary artery bypass graft surgery; warfarin for atrial fibrillation; and angiotensinconverting enzyme inhibitors for heart failure. [116][117][118][119][120] Depression also is underdiagnosed and undertreated in older adults, and effective therapy could increase patient quality of life. 121 Adverse drug reactions are more common in older adults and also may contribute to lower use rates.…”

Section: Drug Underusementioning

confidence: 99%

Pharmacy Practice, Research, Education, and Advocacy for Older Adults

et al. 2005

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In the United States, older adults have become the fastest growing segment of the population and are expected to double in number to 70 million by 2030. As a whole, older adults have different health care needs than younger patients, and some of these needs should be met by pharmacists. Clinical pharmacy practice affecting older adults occurs in a variety of settings, including community, ambulatory care, primary care, hospital, assisted living, nursing home, home health care, hospice, and Alzheimer's disease units. Although specialty training in geriatrics or gerontology is not required for pharmacists to care for older adults, it is extremely helpful. Pharmacy education related to the care of older adults has improved slightly in the past several years but will need to increase even more to provide all pharmacists with the basic skills and knowledge to care for this unique group of patients. In addition, pharmacotherapy research targeting older adults needs to increase. Although it can be challenging, funding for this type of research is available. Patient and political advocacy is also important to support this growing population.

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Preventing recurrent events long term after coronary artery bypass graft: suboptimal use of medications in a population study

Cited by 33 publications

References 29 publications

Optimal Medical Therapy Improves Clinical Outcomes in Patients Undergoing Revascularization With Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting

Optimal Medical Therapy Improves Clinical Outcomes in Patients Undergoing Revascularization With Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting

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

Pharmacy Practice, Research, Education, and Advocacy for Older Adults

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