Ignacio Ferreira-González1, Xavier Carrillo2, Victoria Martín3, José M de la Torre Hernández4, José Antonio Baz5, Josep Navarro Manchón6, Mónica Masotti7, Ángel Cequier8, Mérida Cárdenas9, Fernando Alfonso Manterola10. 1. Unidad de Epidemiología, Servicio de Cardiología, Hospital Universitari Vall d'Hebron, CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address: nacho@ferreiragonzalez.com. 2. Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. 3. Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 4. Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain. 5. Servicio de Cardiología, Hospital Meixoeiro, Vigo, Pontevedra, Spain. 6. Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, Valencia, Spain. 7. Servicio de Cardiología, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain. 8. Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. 9. Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain. 10. Servicio de Cardiología, Hospital Clínico Universitario San Carlos, Madrid, Spain.
Abstract
INTRODUCTION AND OBJECTIVES: To analyze the rate of patients admitted for acute coronary syndrome who concomitantly received acetylsalicylic acid, statins, and angiotensin-converting enzyme inhibitors at discharge, and to analyze interhospital variability in the prescription of these drugs and its potential prognostic impact. METHODS: Interhospital variability in drug prescription was estimated using the intraclass correlation coefficient and median odds ratio (hierarchical analysis). Cox regression analysis was used to estimate the risk of death or myocardial infarction associated with prescription of all 3 agents at 2-years of follow-up. RESULTS: In total, 489 (53.3%) of 917 patients were prescribed all 3 agents. The rate was similar in patients with hypertension and diabetes (56.8%). There was significant variability among centers in the prescription of the 3 drugs at discharge (from 23% to 77% of patients). Hypertension (odds ratio=1.93; 95% confidence interval, 1.42-2.61), ejection fraction < 45% (odds ratio=2.2; 95% confidence interval, 1.44-3.37), being in a clinical trial (odds ratio=1.89; 95% confidence interval, 1.24-2.88), and renal failure (odds ratio=0.53; 95% confidence interval, 0.29-0.94) were associated with prescription of the 3 drugs. After adjustment for these factors, residual variability persisted (intraclass correlation coefficient 0.046 [95% credibility interval, 0.007 to 0.192]; median odds ratio=1.46 [95% credibility interval, 1.16-2.32]). There was no clear association between the prescription of all 3 drugs and the risk of events during follow-up (hazard ratio=0.81, 95% confidence interval, 0.55-1.18; P=.27). CONCLUSIONS: The prescription rate for acetylsalicylic acid, angiotensin-converting enzyme inhibitors, and statins after acute coronary syndrome is suboptimal, varies among centers, and is possibly related to different health care approaches.
INTRODUCTION AND OBJECTIVES: To analyze the rate of patients admitted for acute coronary syndrome who concomitantly received acetylsalicylic acid, statins, and angiotensin-converting enzyme inhibitors at discharge, and to analyze interhospital variability in the prescription of these drugs and its potential prognostic impact. METHODS: Interhospital variability in drug prescription was estimated using the intraclass correlation coefficient and median odds ratio (hierarchical analysis). Cox regression analysis was used to estimate the risk of death or myocardial infarction associated with prescription of all 3 agents at 2-years of follow-up. RESULTS: In total, 489 (53.3%) of 917 patients were prescribed all 3 agents. The rate was similar in patients with hypertension and diabetes (56.8%). There was significant variability among centers in the prescription of the 3 drugs at discharge (from 23% to 77% of patients). Hypertension (odds ratio=1.93; 95% confidence interval, 1.42-2.61), ejection fraction < 45% (odds ratio=2.2; 95% confidence interval, 1.44-3.37), being in a clinical trial (odds ratio=1.89; 95% confidence interval, 1.24-2.88), and renal failure (odds ratio=0.53; 95% confidence interval, 0.29-0.94) were associated with prescription of the 3 drugs. After adjustment for these factors, residual variability persisted (intraclass correlation coefficient 0.046 [95% credibility interval, 0.007 to 0.192]; median odds ratio=1.46 [95% credibility interval, 1.16-2.32]). There was no clear association between the prescription of all 3 drugs and the risk of events during follow-up (hazard ratio=0.81, 95% confidence interval, 0.55-1.18; P=.27). CONCLUSIONS: The prescription rate for acetylsalicylic acid, angiotensin-converting enzyme inhibitors, and statins after acute coronary syndrome is suboptimal, varies among centers, and is possibly related to different health care approaches.
Authors: Juan Miguel Ruiz-Nodar; María Asunción Esteve-Pastor; Jose Miguel Rivera-Caravaca; Miriam Sandín; Teresa Lozano; Nuria Vicente-Ibarra; Esteban Orenes-Piñero; Manuel Jesús Macías; Vicente Pernías; Luna Carrillo; Elena Candela; Andrea Veliz; Antonio Tello-Montoliu; Juan Gabriel Martínez Martínez; Francisco Marín Journal: Br J Clin Pharmacol Date: 2020-02-03 Impact factor: 4.335