Prescription Of Antiplatelet Therapy Research Articles

Influence of sex on the timing of coronary angiography and the prescription of antiplatelet therapy in patients with nonST-segment elevation myocardial infarction.

To assess differences in the clinical management of nonST-segment elevation myocardial infarction (NSTEMI), including in-hospital events, according to biological sex. Prospective observational multicenter study of patients diagnosed with NSTEMI and atherosclerosis who underwent coronary angiography. We enrolled 1020 patients in April and May 2022; 240 (23.5%) were women. Women were older than men on average (72.6 vs 66.5 years, P .001), and more women were frail (17.1% vs 5.6%, P .001). No difference was observed in pretreatment with any P2Y12 inhibitor (prescribed in 68.8% of women vs 70.2% of men, P = .67); however, more women than men were prescribed clopidogrel (56% vs 44%, P = .009). Women prescribed clopidogrel were more often under the age of 75 years and not frail. Coronary angiography was performed within 24 hours less corooften in women (29.8% vs 36.9%, P = .03) even when high risk was recognized. Frailty was independently associated with deferring coronary angiography in the adjusted analysis; biological sex by itself was not related. The frequency and type of revascularization were the same in both sexes, and there were no differences in in-hospital cardiovascular events. Women were more often prescribed less potent antithrombotic therapy than men. Frailty, but not sex, correlated independently with deferral of coronary angiography. However, we detected no differences in the frequency of coronary revascularization or in-hospital events according to sex.

Abstract TMP64: Time-Trends and Determinants of Dual Antiplatelet Therapy Prescription After Acute Moderate-to-Severe Non-Cardioembolic Ischemic Stroke

Introduction: Short-term dual antiplatelet therapy (DAPT) lowers the risk of early stroke recurrence after mild non-cardioembolic ischemic stroke (NCIS) and high-risk transient ischemic attack. However, DAPT benefit in moderate-to-severe NCIS is unknown. We sought to investigate time-trends and determinants of DAPT prescription after moderate-to-severe NCIS in the Florida Stroke Registry (FSR). Methods: Within 168 FSR-participating hospitals, between January 2010 and September 2022, we analyzed NCIS patients with NIHSS score >3, without other indication(s) for DAPT (e.g., carotid stenting) or systemic anticoagulation, hemorrhagic complications, and whom received at least one antiplatelet agent upon discharge. Using single antiplatelet therapy (SAPT) as comparison, we assessed DAPT determinants through logistic regression models adjusted for demographics, hospital characteristics, clinical presentation, vascular risk factors and stroke subtype. Results: Out of 283,264 ischemic stroke patients during the study period, 53,282 had moderate-to-severe NCIS (mean age 68 +/-14 years, 50% women, median presenting NIHSS score 7 [interquartile range 6]). DAPT was prescribed in 15,107 (28.4%) and SAPT in 38,175 (71.6%). DAPT prescription increased from 24.2% in 2010 to 44.8% in 2022 (Figure 1). Independent determinants of DAPT prescription are shown in Table 1. Conclusion: DAPT prescription after moderate-to-severe NCIS is common now, and has nearly doubled over the past decade. Major DAPT determinants were premorbid SAPT and large-artery atherosclerosis. Further research may determine DAPT efficacy and safety in this population.

Discharge prescription patterns for antiplatelet and statin therapy following carotid endarterectomy: an analysis of the vascular quality initiative

ObjectivesDespite guidelines endorsing statin and single antiplatelet therapy (SAPT) therapy post-carotid endarterectomy (CEA), these medications may be either under or inappropriately prescribed. We determined rates of new statin prescriptions as...

Oral factor Xa inhibitor underutilization following lower extremity peripheral vascular intervention

ObjectivePatients undergoing peripheral vascular intervention (PVI) (ie, endovascular revascularization) for symptomatic lower extremity peripheral artery disease remain at high risk for major adverse limb and cardiovascular events. High-quality evidence demonstrates the addition of a low-dose oral factor Xa inhibitor to single antiplatelet therapy, termed dual pathway inhibition (DPI), reduces the incidence of major adverse events in this population. This study aims to describe the longitudinal trends in factor Xa inhibitor initiation after PVI, identify patient and procedural characteristics associated with factor Xa inhibitor use, and describe temporal trends in antithrombic therapy post-PVI before vs after VOYAGER PAD. MethodsThis retrospective cross-sectional study was performed using data from the Vascular Quality Initiative PVI registry from January 2018 through June 2022. Multivariate logistic regression was utilized to determine predictors of factor Xa inhibitor initiation following PVI, reported as odds ratios (ORs) with 95% confidence intervals (CIs). ResultsA total of 91,569 PVI procedures were deemed potentially eligible for factor Xa inhibitor initiation and were included in this analysis. Overall rates of factor Xa inhibitor initiation after PVI increased from 3.5% in 2018 to 9.1% in 2022 (P < .0001). The strongest positive predictors of factor Xa inhibitor initiation after PVI were non-elective (OR, 4.36; 95% CI, 4.06-4.68; P < .0001) or emergent (OR, 8.20; 95% CI, 7.14-9.41; P < .0001) status. The strongest negative predictor was postoperative dual antiplatelet therapy prescription (OR, 0.20; 95% CI, 0.17-0.23; P < .0001), highlighting significant hesitation about use of DPI after PVI and limited translation of VOYAGER PAD findings into clinical practice. Antiplatelet medications remain the most common antithrombotic regimen after PVI, with almost 70% of subjects discharged on dual antiplatelet therapy and approximately 20% discharged on single antiplatelet therapy. ConclusionsFactor Xa inhibitor initiation after PVI has increased in recent years, although the absolute rate remains low, and most eligible patients are not prescribed this treatment.

Anticoagulation in older people with atrial fibrillation moving to care homes: a data linkage study.

Treatment decisions about oral anticoagulants (OACs) for atrial fibrillation (AF) are complex in older care home residents. To explore factors associated with OAC prescription. Retrospective cohort study set in care homes in Wales, UK, listed in the Care Inspectorate Wales Registry 2017/18. Analysis of anonymised individual-level electronic health and administrative data was carried out on people aged ≥65 years entering a care home between 1 January 2003 and 31 December 2018, provisioned from the Secure Anonymised Information Linkage Databank. Between 2003 and 2018, 14 493 people with AF aged ≥65 years became new residents in care homes in Wales and 7057 (48.7%) were prescribed OACs (32.7% in 2003 compared with 72.7% in 2018) within 6 months before care home entry. Increasing age and prescription of antiplatelet therapy were associated with lower odds of OAC prescription (adjusted odds ratio [aOR] 0.96 per 1-year age increase, 95% confidence interval [CI] = 0.95 to 0.96 and aOR 0.91, 95% CI = 0.84 to 0.98, respectively). Conversely, prior venous thromboembolism (aOR 4.06, 95% CI = 3.17 to 5.20), advancing frailty (mild: aOR 4.61, 95% CI = 3.95 to 5.38; moderate: aOR 6.69, 95% CI = 5.74 to 7.80; and severe: aOR 8.42, 95% CI = 7.16 to 9.90), and year of care home entry from 2011 onwards (aOR 1.91, 95% CI = 1.76 to 2.06) were associated with higher odds of an OAC prescription. There has been an increase in OAC prescribing in older people newly admitted to care homes with AF. This study provides an insight into the factors influencing OAC prescribing in this population.

Factors associated with prescription of oral anticoagulation for atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003–2018

Abstract Background Prescription of oral anticoagulants (OAC) is paramount for stroke prevention in people with atrial fibrillation (AF), but treatment decisions in older care home residents are complicated by frailty, multi-morbidity and heightened stroke and bleeding risk. There is a paucity of data on factors influencing the decision to prescribe OAC in this high-risk population who are under-represented in research studies. Purpose To explore the factors associated with OAC prescription for care home residents aged ≥65 years with AF. Methods Nationwide retrospective cohort study of people aged ≥65 years entering a care home in Wales between 1 January 2003 and 31 December 2018, using anonymised individual-level electronic health record and administrative data sources available within the Secure Anonymised Information Linkage Databank. Unadjusted and adjusted logistic regression models were used to explore the association between resident characteristics and OAC prescription or non-prescription. Results Between 2003 and 2018, 14,493 people with AF aged ≥65 years became new residents in care homes in Wales and 7,057 (48.7%) were prescribed OAC (32.7% in 2003 compared to 72.7% in 2018), Figure 1. Increasing age and prescription of antiplatelet therapy were associated with lower odds of OAC prescription (adjusted odds ratio [aOR] 0.96 per one year age increase [95% confidence interval, 0.95 to 0.96] and aOR 0.91 [0.84 to 0.98], respectively). Conversely, prior venous thromboembolism (aOR 4.06 [3.17 to 5.20]), advancing frailty (mild: aOR 4.61 [3.95 to 5.38]; moderate: aOR 6.69 [5.74 to 7.80]; severe: aOR 8.42 [7.16 to 9.90]) and year of care home entry in the post-non-vitamin K antagonist oral anticoagulant (NOAC) era from 2011 onwards (aOR 1.91 [1.76 to 2.06]) were associated with higher odds of OAC prescription, Figure 2. Conclusions The proportion of care home residents prescribed OAC therapy has increased over time with the introduction of NOACs in 2011, but OAC prescription rates are still sub-optimal. Although there is an expected rise in OAC prescribing for increasingly frail people, further work is needed to investigate the interaction with deprivation and other socio-economic and demographic factors to assess potential inequalities in prescribing across these groups. Targeted educational tools for clinicians are needed to address barriers to OAC prescription for AF, such as older age and separate indications for antiplatelet therapy. Funding Acknowledgement Type of funding sources: None.

Antiplatelet therapy use for the secondary prevention of cardiovascular disease in 2009–2017: a population-wide retrospective cohort study of Scotland

Abstract Background Few studies have analysed the adequacy of antiplatelet therapy (APT) use for secondary prevention of atherosclerotic cardiovascular disease (ASCVD). Some studies found utilisation to be suboptimal. However, information on the extent of APT use at different treatment stages and over time, and the role of particular individual characteristics, is limited. Purpose To use large-scale population-wide individual patient data to investigate the extent of, and determinants for, suboptimal use of effective APT, in order to identify patient groups that could be targeted to improve medication use. Methods This retrospective open cohort study used anonymised large-scale population-wide individual patient NHS Scotland data (hospital admissions, national death records, prescribing information and speciality mental health admissions) for all individuals hospitalised for ASCVD (based on ICD-10 discharge codes) in Scotland between 1 October 2009 and 31 December 2017. APT initiation was defined as a prescription of APT within 90 days of ASCVD hospital discharge with dispensing within 60 days of the prescription. Adherence was defined as ≥80% of days covered with dispensed therapy. Discontinuation of APT was defined as a treatment gap of 180 days or more since initiation. Multivariable cross-sectional logistic regression and Cox proportional hazards models were used to study the relevance of patient characteristics (e.g., demographic, clinical, socioeconomic) to the likelihood of, respectively, initiating or discontinuing APT. Findings are reported for all ASCVD events and, separately, for myocardial infarction (MI), ischaemic stroke, peripheral arterial disease (PAD) and other ASCVD events. Results Of 150,728 individuals hospitalised for ASCVD (excluding any diagnosis of atrial fibrillation), 16% did not initiate any APT. Initiation was less common in women (22% less likely than men), people aged ≥70 or &amp;lt;50 (21% and 39% less likely for patients in their 70s and 80s respectively vs. 60s; 26% less likely for patients below age 50 vs. 60s), people living in more deprived areas, people receiving specialist mental health care and people with multiple morbidities (Figure). There was substantial variation for lack of initiation across ASCVD types (e.g., MI 6%, PAD: 32%). In 2015/17, 72% of MI patients and 69% of patients undergoing percutaneous coronary intervention received guideline-recommended dual-APT. While on treatment, 93% of users were adherent. However, about a quarter (23%) discontinued treatment. Similar characteristics linked to lack of initiation of APT were associated with an increased risk of discontinuation. Conclusions APT initiation and persistence remain suboptimal, especially in women, people aged below 50 years and 70 years or older, people with multiple morbidities or mental illness, and following non-MI ASCVD events. This needs to be addressed by clinicians and policy-makers to further reduce cardiovascular risk. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Oxford British Heart Foundation Centre of Research Excellence (BHF CRE) Pump Priming Scheme; Medical Research Council Doctoral Training Programme (MRC DTP) studentship.

Where do we stand with acute myocardial infarction patients with severely reduced left ventricular ejection fraction? insights from AMIS Plus Registry

Abstract Background Left ventricular ejection fraction (LVEF) represents one of the strongest predictors of both in-hospital and long-term prognosis in acute myocardial infarction (AMI). Temporal trends data coming from real-word experiences focused on AMI patients with severely reduced LVEF (i.e. &amp;lt;30%) are lacking. Purpose The present study aims at providing a comprehensive picture on temporal trends in AMI patients with severely reduced LVEF, with a particular focus on prevalence, in-hospital management/prognosis and pharmacological therapy at discharge. These data could shed light on the implementation in the clinical arena of guideline-directed therapies in this fragile subgroup of patients and on their effect on real-word short-term prognosis. Methods On a total of 48,543 screened AMI patients included in AMIS Plus Registry between 2005 and 2020, data on LVEF were available for 23,510 patients. Study patients were classified according to LVEF as AMI patients with or without severely reduced LVEF (i.e. patients with LVEF &amp;lt;30% and ≤30%, respectively). Results Overall, 1657 AMI patients (7%) presented with severely reduced LVEF. Prevalence of severe LVEF reduction constantly decreased over the study period (from 11% to 4%, p&amp;lt;0.001; Figure 1). In the subgroup of patients with severely reduced LVEF a significant increase in revascularisation (percutaneous and/or surgical) rate was observed (from 61% to 84%, p&amp;lt;0.001); in-hospital access to advanced short-term mechanical circulatory support (both ECMO and/or Impella) significantly increased from 0% in 2011 to 17% (p=0.05). Rate of cardiogenic shock developed during hospitalization remained stable over time (from 21% to 16%, p=0.7); in-hospital mortality did not significantly decrease and remained well above 20% all over the study period (from 23% to 26%, p=0.65; Figure 2). At discharge, prescription of optimal anti-ischaemic therapy (defined as an association of dual antiplatelet therapy and statine) significantly increased (from 47% to 75%, p&amp;lt;0.001), mainly driven by an increase in dual antiplatelet therapy prescription; however, prescription of optimal cardio-protective therapy (defined as an association of renin-angiotensin-aldosterone-system inhibitors, beta-blocker and mineralcorticoid receptor antagonist) remained low across the study period (from 17% in 2011 to 20%, p=0.96). Conclusion AMI patients with severely reduced ejection fraction still remain a fragile subgroup of patients; in-hospital mortality did not significantly decrease and remained exceedingly high and well above 20% all over the study period; efforts are, therefore, urgently needed to develop therapeutic strategies focused on this subgroup of patients and aiming at improving short-term prognosis. Moreover, access at discharge to optimal cardio-protective therapy remains suboptimal; efforts are needed to improve access to guidelines-directed therapy both at discharge and follow-up in this fragile population. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Swiss Heart Fundation

Platelet aggregation inhibitor prescription for newly diagnosed peripheral arterial disease in the Netherlands: a cohort study

ObjectivesPharmacological treatment of peripheral arterial disease (PAD) comprises of antiplatelet therapy (APT), blood pressure control and cholesterol optimisation. Guidelines provide class-I recommendations on the prescription, but there are little data...

Trends of prescribing adherence of antiplatelet agents in Hong Kong patients with acute coronary syndrome: a 10-year retrospective observational cohort study

ObjectivesThe objective of this study is to examine the temporal trend of antiplatelet prescribing pattern during index hospitalisation discharge in Hong Kong (HK) acute coronary syndrome (ACS) population.DesignThe study is...

Antiplatelet patterns and outcomes in patients with atrial fibrillation not prescribed an anticoagulant after stroke

BackgroundTo determine association of discharge antiplatelet therapy prescription with 1-year outcomes among patients with AF admitted with acute ischemic stroke and discharged without oral anticoagulation. MethodsIn a retrospective cohort study from the Get With The Guidelines-Stroke registry, we identified all Medicare fee-for-service beneficiaries 65 years or older with AF or atrial flutter admitted with acute ischemic stroke and discharged without oral anticoagulation from April 2003 through December 2014, and we determined association of discharge antiplatelet therapy prescription with 1-year outcomes using Medicare claims data. Primary outcomes were 1-year mortality and composite endpoint of major adverse cardiovascular/neurologic/bleeding events (MACNBE). ResultsOf 64,228 subjects (median [interquartile range] age, 84 [78–89] years; 62.5% female), 54,621 (85.0%) were discharged with antiplatelet therapy, and 9607 (15.0%) were discharged with no antithrombotic therapy. The unadjusted rates of 1-year mortality were lower among patients receiving antiplatelet therapy (37.3%) than among those receiving no antithrombotic therapy (48.1%); unadjusted rates of MACNBE were lower for those receiving antiplatelet therapy (45.5%) compared with those receiving no antithrombotic therapy (55.2%). After adjusting for potential confounders, antiplatelet therapy prescription was associated with reduced 1-year mortality (adjusted hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.62–0.66, P < .001) and MACNBE (adjusted HR 0.69, 95% CI 0.67–0.71, P < .001). ConclusionsAmong Medicare beneficiaries with AF admitted for acute ischemic stroke but not discharged on oral anticoagulant therapy, antiplatelet therapy, compared with no antithrombotic therapy, was associated with reduced 1-year mortality and MACNBE.

Renal arteriography with endovascular ultrasound for the management of renal infarction patients

BackgroundRenal infarction (RI) is a rare disease with poor prognosis. Appropriate secondary prevention treatment is essential and requires an exhaustive etiological assessment. We aimed to determine whether invasive endovascular explorations may improve the diagnostic process and change the secondary prevention treatment strategy in RI patients.MethodsWe report a retrospective observational study of 25 RI patients referred to Tours University Hospital between 2011 and 2018 for etiological investigation including renal arteriography and intravascular ultrasonography (IVUS). We sought for antithrombotic treatment regimen, vital status, bleeding and ischemic outcomes during the median follow-up of 59 months.ResultsInvasive explorations showed local arterial disease in 14 patients (56%). This led to a diagnosis or change in diagnosis in 9 patients (36%) and to a change in antithrombotic strategy in 56% of cases, with an increased prescription of antiplatelet therapy. No patient died, only two patients (8%) had persistent mild renal insufficiency. One IVUS complication was reported and treated without any significant long-term consequences.ConclusionInvasive endovascular investigations of RI may modify the secondary prevention treatment through a better assessment of the aetiology of RI. Multicentric randomized studies are necessary to advocate the hypothesis that invasive exploration of renal artery can improve long-term prognosis.

Abstract 159: Trends in Dual Antiplatelet Therapy Prescription Patterns for Secondary Prevention in Patients With Noncardioembolic Ischemic Stroke

Background: The recommendations for dual antiplatelet (DAPT aspirin + clopidogrel) for secondary stroke prevention has evolved over time. Following the publication of CHANCE trial (07/2013), the AHA/ASA updated the DAPT recommendations from Class III harm (10/2010) for patient with noncardioembolic ischemic stroke, to Class IIb benefit ≥ risk (02/2014), and Class IIa benefit &gt;&gt; risk (03/2018) for a subgroup of patients with minor stroke (NIHSS≤3). Subsequent to the last guideline update, the POINT trial (05/2018) provided further support for the effectiveness of DAPT. Methods: We evaluated antiplatelet prescription patterns of 1,024,074 noncardioembolic ischemic stroke survivors (median age 65 years and 46% women) eligible for antiplatelet therapy (no contraindications) and discharged from the Get With The Guidelines-Stroke Hospitals between Q1 2011 and Q1 2019. Results: Baseline patient characteristics were similar within the four periods: pre-CHANCE (01/2011-07/2013), pre-2014 guideline update (08/2013-02/2014), pre-POINT/2018 guideline update (03/2014-05/2018), and post-POINT (06/2018-03/2019). Use of DAPT gradually increased from 16.7% in the pre-CHANCE period, to 19.4% pre-2014 guideline update, 23.3% pre-POINT/2018 guideline update, and 29.8% post-POINT period (p&lt;0.001, Figure). Yet increase in DAPT use was observed over time for individuals with NIHSS≤3 (17.1%, 19.9%, 24.1%, and 31.4%, p&lt;0.001) and those with NIHSS&gt;3 (18.7%, 22.8%, 28.3%, and 28.3%, p&lt;0.001). Conclusions: A sustained increase in DAPT use for secondary stroke prevention was observed after publication of pivotal trials and AHA guideline updates. While recommended for minor strokes or TIA only, such increase was also observed in ischemic stroke patients with NIHSS&gt;3, where the risk-benefit ratio of DAPT remains to be established.

Underuse of Oral Anticoagulants and Inappropriate Prescription of Antiplatelet Therapy in Older Inpatients with Atrial Fibrillation.

Several studies have shown that the prescription of antiplatelet therapy (APT) is associated with an increased risk of oral anticoagulant (OAC) underuse in patients aged 75years and over with atrial fibrillation (AF). An associated atheromatous disease may be the underlying reason for APT prescription. The objective of the study was to determine whether the association between underuse of OAC and APT prescription was explained by the presence of an atheromatous disease. We performed a retrospective, observational, single-centre study between 2009 and 2013 based on administrative data. Patients aged 75years and over with non-valvular AF were identified in a database of 72,090 hospital stays. Prescriptions of anti-thrombotic medications and their association with the presence of atheromatous disease were evaluated by the mean of a logistic regression. A total of 2034 hospital stays were included (mean age 84.3±5.2years). The overall prevalence of known atheromatous disease was 25.9%. OAC underuse was observed in 58.5% of the stays. In multivariable analysis, the prescription of an APT was associated with an increased risk of OAC underuse [odds ratio (OR) 6.85; 95% confidence interval (CI) 5.50-8.58], independently of the presence of a concomitant known atheromatous disease (OR 0.78; 95% CI 0.60-1.01). Among the 692 stays with APT monotherapy (34.0%), 232 (33.5%) displayed an atheromatous disease. The underuse of OAC is associated with the prescription of APT in older patients with AF, regardless of the presence or absence of known atheromatous disease. Our results suggest that APT is often inappropriately prescribed instead of OAC.

Quality of secondary prevention of coronary heart disease in Swiss primary care: Lessons learned from a 6-year observational study

IntroductionAcross Europe, great variations have been identified in the quality of preventive healthcare services delivered in primary care (PC). We aimed to assess the quality of secondary prevention in Swiss PC patients with coronary heart disease (CHD) and its evolution over six years. MethodsIn the database of the Swiss «Family Medicine ICPC Research using Electronic Medical Records» (FIRE) project, we identified electronical record data of 2,807 patients with CHD treated for at least 15 months between 2009 and 2014. Primary outcome was the proportion of patients per year meeting four quality indicators of the British Quality and Outcome Framework (QOF): 1) blood pressure (BP) ≤ 150mmHg, 2) total serum cholesterol ≤ 5mmol/L, 3) prescription of anti-platelet therapy, 4) recommended drug prescriptions for patients with previous myocardial infarction (MI). Secondary outcome was the proportion of patients who were ineligible for indicator calculation because of incomplete record data. ResultsFrom 2009 to 2014, 85.9, 83.1, 82.0, 81.9, 81.5, and 81.0 % of the patients met BP targets and 73.6, 77.0, 69.2, 73.6, 69.4, and 69.1% met cholesterol targets. Anti-platelet therapy was prescribed to 74.8, 76.1, 73.9, 70.2, 72.2, and 72.5 % of the patients. Finally, 83.3, 84.4, 87.5, 75.6, 89.8, and 89.2 % of the patients with previous MI received the recommended drug therapy. Changes over time were not significant. Missing BP records concerned 12.4–15.9 % of the patients, and missing cholesterol records 69.0–75.6 %. Females and patients with less cardiovascular comorbidities were more likely to show missing records. ConclusionsQuality of secondary prevention did not improve when measured against QOF indicators in the period under investigation. Missing data in electronic medical records inhibited full quality indicator assessment. Especially in female patients and those with less cardiovascular comorbidity, closer medical documentation should be encouraged in order to facilitate quality of care measurements.

Treatment of patient with high-risk hypertension: do we need antiplatelet therapy?

This review summarizes the main problems of acetylsalicylic acid (ASA) use in clinical practice. The prescription of antiplatelet therapy for primary cardiovascular prevention is the most controversial. The available clinical guidelines are contradictory. Antiplatelet drugs are the most commonly prescribed medication in routine practice, and the rates are growing. The article reviews the data of clinical trials and basic meta-analysis on the effectiveness and safety of ASA in patients with hypertension (HTN), diabetes mellitus (DM), renal dysfunction, as well as age- and gender-associated differences. Additional criteria are considered in high-risk patients. A special attention is paid to the main clinical recommendations regarding the use of ASA in patients with HTN and DM. Common use of ASA increases the risk of complications and requires the search for possible preventive approaches. Thus, the main risk groups for gastrointestinal bleeding are listed. Moreover, the main preventive approaches regarding the various forms of ASA, the use of adjunctive therapy by secretion blockers and eradication therapy are discussed.

Antiplatelet therapy prescription for patients with ST elevation myocardial infarction (STEMI): insights from the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI)

Antiplatelet therapy prescription for patients with ST elevation myocardial infarction (STEMI): insights from the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI)

Mortality in neuropsychiatric systemic lupus erythematosus (NPSLE)

The standardized mortality ratio (SMR) for systemic lupus erythematosus (SLE) is three; SMR increases to six in case of renal involvement. Up to now data on survival in case of neuropsychiatric involvement in SLE (NPSLE) have been scarce, therefore we calculated an SMR for NPSLE. Furthermore, we identified characteristics that influenced survival by Cox regression analyses. All patients suspected of NPSLE in our center since 1989 were evaluated and included in this study when a diagnosis of primary NPSLE could be established. Patient's life/death status was tracked using the civic registries. Thirty-two (19%) of the 169 included NPSLE patients died within a median follow-up period of six years (range 0.5-24 years). This resulted in a significantly increased mortality rate compared to the general population: SMR 9.5 (95% CI 6.7-13.5). Hazard ratios (HRs) were highest in patients with acute confusional state (HR 3.4) and older age at diagnosis of NPSLE (HR 1.1). A decreased mortality risk was seen with the prescription of antiplatelet therapy (HR 0.22). The time period in which NPSLE was diagnosed did not significantly influence survival. Most frequent causes of death were infection and NPSLE itself.

Control of baseline cardiovascular risk factors in the SU-FOL-OM3 study cohort: does the localization of the arterial event matter?

No data are currently available on the prevalence and control of cardiovascular (CV) risk factors in secondary prevention depending on the cardiac or cerebral localization of the ischemic disease. We investigated the prevalence and control of modifiable CV risk factors, as well as the determinants of CV risk factors' control and adequate treatment in a secondary prevention cohort, the SU-FOL-OM3 study cohort, to determine the role of the localization of the ischemic disease including events. A total of 2491 patients were included in the study. The prevalence of all modifiable risk factors was high in both coronary heart disease and cerebrovascular disease (CVD) groups. Control of all risk factors and the presence of antiplatelet medication were noted in 29.6% of patients with coronary heart disease and 11% of patients with CVD. The cardiac localization of the including event was independently associated with the control of each of the risk factors studied (hypertension, low-density lipoprotein-cholesterol, smoking) and to the control of all risk factors present and prescription of antiplatelet therapy with an odds ratio (95% confidence interval) of 2.72 (1.97-3.75). There is a need to improve the control of CV risk factors in secondary prevention patients. This is particularly crucial for patients with CVD.

Improving Diabetes Care Through a Multicomponent Quality Improvement Model in a Practice-Based Research Network

This article reports the impact of a multicomponent quality improvement intervention on adherence with 13 measures of diabetes care and a summary measure, the Diabetes Summary Quality Index (Diabetes-SQUID). The intervention was conducted between January 1, 2004, and July 1, 2005, within 66 primary care practices in 33 states, including 372 providers and 24 250 adult patients with diabetes. Across all practices, the average Diabetes-SQUID was 50.6% (10th percentile 36.5%, 90th percentile 63.0%) on January 1, 2004, and 58.4% (10th percentile 47.6%, 90th percentile 69.7%) on July 1, 2005, with an average absolute improvement of 7.8% (95% confidence interval, 5.9%-9.7%). Significant improvements occurred for 12 of the 13 individual measures: blood pressure and urine microalbumin monitoring; HDL cholesterol, LDL cholesterol, triglyceride, and glycosylated hemoglobin measurements; prescription of antiplatelet therapy; and blood pressure, HDL-cholesterol, LDL-cholesterol, triglyceride, and glycosylated hemoglobin control. The findings suggest that a multicomponent intervention can have a robust impact on quality of care for diabetes.