Suboptimal medical therapy for ACS patients is associated with increased mortality
Trends in Optimal Medical Therapy Prescription and Mortality After Admission for Acute Coronary Syndrome: a 9-Year Experience in a Real-World SettingLiterature - Hoedemaker NPG, Damman P, Ottervanger JP, et al. - Eur Heart J - CV Pharmacotherapy 2018
- During 9 years, a total of 9,202 consecutive patients were included, with a mean age of 65.7 years. 29.9% of patients were women, and 61.1% of patients had a STEMI.
- Prescription was known in 91.1% of patients alive at discharge, 77.5% at 30 days, and 58.7% at 1 year.
- Prescription of APS at discharge, 30-days, and 1-year was 70.6%, 70.8% and 44.6% respectively, and 46.6%, 51.4%, and 29.4% for OMT. Use of OMT did not change significantly for the duration of the study, despite the change of ESC guidelines during this period.
- There were no significant changes in all-cause and cardiac in-hospital, 30-day, and 1-year mortality during the study period.
- OMT prescription at discharge was associated with a reduction in 1-year mortality before and after adjustment (HR: 0.35; 95%CI: 0.28-0.44; HRadj: 0.66; 95%CI: 0.46-0.93).
- In patients with a known IA indication for both beta-blockers and ACEi/ARBs (i.e. LVEF ≤40%, in 48.5% of patients with this data available) at discharge, co-prescription of at least beta-blockers and ACEi/ARBS was 66.0%, and OMT prescription at discharge was 41.6%.
In a single-center observational study, less than 50% of acute coronary syndrome patients were on aspirin, P2Y12 inhibitor, statin, beta-blocker, and ACEi/ARB at discharge. The prescription of these recommended therapies at discharge was associated with a reduction in 1-year mortality.