Is Use of Evidence-Based Medications One Year After an Acute Coronary Syndrome Related to the Severity of Left Ventricular Systolic Dysfunction?

Abstract

Beta blockers (BB), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB), and mineralocorticoid receptor antagonists (MRA) improve outcomes following an acute coronary syndrome (ACS) in patients with a reduced left ventricular ejection fraction (LVEF). Treatment benefits are greater with lower LVEF and higher dose. Dispensing of BB, ACEi/ARB, and MRA, and the number (%) taking ≥50% of the recommended dose at one year were audited in 1,444 ACS patients admitted to three New Zealand hospitals between 2015 and 2019, who had a predischarge LVEF <50%, and were alive at 12 months. Results are summarised in the Table.TableMedication dispensedLVEF <30% n=159LVEF 30%–40% n=606LVEF 41%–<50% n=679Beta blockerDischarge143 (90%)503 (83%)563 (83%)One year119 (75%)478 (79%)533 (78%)Dose ≥50% recommended48 (30%)131 (22%)119 (18%)ACEi or ARBDischarge137 (86%)483 (80%)561 (83%)One year108 (68%)471 (77%)535 (79%)Dose ≥50% recommended27 (17%)127 (21%)131 (19%)MRADischarge52 (33%)87 (14%)26 (4%)One year49 (31%)97 (16%)34 (5%)Dose ≥50% recommended27 (17%)60 (10%)21 (3%) Open table in a new tab In ACS patients with a reduced LVEF, evidence-based medications were poorly targeted to those with the lowest LVEF, often stopped after discharge, and the dose seldom increased. Strategies are needed to improve long-term use of evidence-based medications, especially in high-risk patients. This study is consistent with other large registries.