Baris Gencer1, Nicolas Rodondi2, Reto Auer3, Lorenz Räber4, Roland Klingenberg5, David Nanchen3, David Carballo1, Pierre Vogt6, Sebastian Carballo7, Philippe Meyer1, Christian M Matter5, Stephan Windecker4, Thomas Felix Lüscher5, François Mach1. 1. Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland. 2. Department of General Internal Medicine, University of Bern, Bern, Switzerland. Electronic address: Nicolas.Rodondi@insel.ch. 3. Department of Ambulatory and Community Medicine, University of Lausanne, Lausanne, Switzerland. 4. Department of Cardiology, Bern University Hospital, Bern, Switzerland. 5. Department of Cardiology, Zürich University Hospital, Zürich, Switzerland. 6. Division of Cardiology, Lausanne University Hospital, Lausanne, Switzerland. 7. Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.
Abstract
BACKGROUND: The prescription of recommended medical therapies is a key factor to improve prognosis after acute coronary syndromes (ACS). However, reasons for cardiovascular therapies discontinuation after hospital discharge are poorly reported in previous studies. METHODS: We enrolled 3055 consecutive patients hospitalized with a main diagnosis of ACS in four Swiss university hospitals with a prospective one-year follow-up. We assessed the self-reported use of recommended therapies and the reasons for medication discontinuation according to the patient interview performed at one-year follow-up. RESULTS: 3014 (99.3%) patients were discharged with aspirin, 2983 (98.4%) with statin, 2464 (81.2%) with beta-blocker, 2738 (90.3%) with ACE inhibitors/ARB and 2597 (100%) with P2Y12 inhibitors if treated with coronary stent. At the one-year follow-up, the discontinuation percentages were 2.9% for aspirin, 6.6% for statin, 11.6% for beta-blocker, 15.1% for ACE inhibitor/ARB and 17.8% for P2Y12 inhibitors. Most patients reported having discontinued their medication based on their physicians' decision: 64 (2.1%) for aspirin, 82 (2.7%) for statin, 212 (8.6%) for beta-blocker, 251 (9.1% for ACE inhibitor/ARB) and 293 (11.4%) for P2Y12 inhibitors, while side effect, perception that medication was unnecessary and medication costs were uncommon reported reasons (<2%) according to the patients. CONCLUSIONS: Discontinuation of recommended therapies after ACS differs according the class of medication with the lowest percentages for aspirin. According to patients, most stopped their cardiovascular medication based on their physician's decision, while spontaneous discontinuation was infrequent.
BACKGROUND: The prescription of recommended medical therapies is a key factor to improve prognosis after acute coronary syndromes (ACS). However, reasons for cardiovascular therapies discontinuation after hospital discharge are poorly reported in previous studies. METHODS: We enrolled 3055 consecutive patients hospitalized with a main diagnosis of ACS in four Swiss university hospitals with a prospective one-year follow-up. We assessed the self-reported use of recommended therapies and the reasons for medication discontinuation according to the patient interview performed at one-year follow-up. RESULTS: 3014 (99.3%) patients were discharged with aspirin, 2983 (98.4%) with statin, 2464 (81.2%) with beta-blocker, 2738 (90.3%) with ACE inhibitors/ARB and 2597 (100%) with P2Y12 inhibitors if treated with coronary stent. At the one-year follow-up, the discontinuation percentages were 2.9% for aspirin, 6.6% for statin, 11.6% for beta-blocker, 15.1% for ACE inhibitor/ARB and 17.8% for P2Y12 inhibitors. Most patients reported having discontinued their medication based on their physicians' decision: 64 (2.1%) for aspirin, 82 (2.7%) for statin, 212 (8.6%) for beta-blocker, 251 (9.1% for ACE inhibitor/ARB) and 293 (11.4%) for P2Y12 inhibitors, while side effect, perception that medication was unnecessary and medication costs were uncommon reported reasons (<2%) according to the patients. CONCLUSIONS: Discontinuation of recommended therapies after ACS differs according the class of medication with the lowest percentages for aspirin. According to patients, most stopped their cardiovascular medication based on their physician's decision, while spontaneous discontinuation was infrequent.
Authors: Marie-Eva Laurencet; François Girardin; Fabio Rigamonti; Anne Bevand; Philippe Meyer; David Carballo; Marco Roffi; Stéphane Noble; François Mach; Baris Gencer Journal: PLoS One Date: 2016-08-23 Impact factor: 3.240
Authors: Baris Gencer; Konstantinos C Koskinas; Lorenz Räber; Alexios Karagiannis; David Nanchen; Reto Auer; David Carballo; Sebastian Carballo; Roland Klingenberg; Dik Heg; Christian M Matter; Thomas F Lüscher; Nicolas Rodondi; François Mach; Stephan Windecker Journal: J Am Heart Assoc Date: 2017-11-09 Impact factor: 5.501
Authors: Lisandro D Colantonio; Robert S Rosenson; Luqin Deng; Keri L Monda; Yuling Dai; Michael E Farkouh; Monika M Safford; Kiran Philip; Katherine E Mues; Paul Muntner Journal: J Am Heart Assoc Date: 2019-01-08 Impact factor: 5.501
Authors: David Carballo; Nicolas Rodondi; Reto Auer; Sebastian Carballo; David Nanchen; Lorenz Räber; Roland Klingenberg; Pierre-Frédéric Keller; Dik Heg; Peter Jüni; Olivier Muller; Christian M Matter; Thomas F Lüscher; Stephan Windecker; Francois Mach; Baris Gencer Journal: PLoS One Date: 2019-02-21 Impact factor: 3.240
Authors: Baris Gencer; Nicolas Rodondi; Reto Auer; David Nanchen; Lorenz Räber; Roland Klingenberg; Mark Pletscher; Peter Jüni; Stephan Windecker; Christian M Matter; Thomas F Lüscher; François Mach; Thomas V Perneger; François R Girardin Journal: Open Heart Date: 2016-05-23