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.
Highlights
The prescription of guideline-recommended medication for secondary prevention after acute coronary syndrome has been suboptimal in the past
In this study we investigated guideline adherence and associated patient, care and hospital characteristics for secondary prevention medication at discharge from the hospital for patients with acute coronary syndrome (ACS) in the Netherlands during implementation of a nationwide quality improvement program
STEMI ST-segment elevation myocardial infarction, NSTEMI non-ST-segment elevation myocardial infarction, UA unstable angina pectoris, PCI percutaneous coronary intervention, CABG coronary artery bypass grafting, confidence intervals (CI) confidence interval, N/A not applicable, BMI body mass index, MI myocardial infarction aP-values are calculated using the Wald statistic, comparing the model fit of a generalized linear mixed model with and without the variable, corrected for clustering of patients in hospitals bLength of stay was log-transformed after careful consideration of the residuals of a model without random intercept cHyperlipidaemia was defined as described in patients history or statin use before admission sex; and discharge diagnosis with treatment and sex
Summary
Guideline adherence for secondary prevention medication following acute coronary syndrome was substantial; variation between hospitals and patient groups was found. Efforts to increase guideline adherence can focus on underperforming hospitals and undertreated patient groups. Keywords Acute coronary syndrome · Secondary prevention · Guideline adherence · Quality indicators · Acute coronary syndrome/drug therapy · Patient discharge
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Schedule a callMore From: Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
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