Missed opportunity: a clinical data linkage study of guideline-directed medical therapy and clinical outcomes of patients discharged with acute coronary syndrome who attended cardiac rehabilitation programs

IF 1 Q4 PHARMACOLOGY & PHARMACY
Lemlem G. Gebremichael PhD, Alline Beleigoli PhD, Jonathon W. Foote RN, ICU Cert, ACE, Norma B. Bulamu PhD, Joyce S. Ramos PhD, Orathai Suebkinorn RN, MSN, Julie Redfern PhD, Robyn A. Clark PhD, the National Health and Medical Research Council (NHMRC) Country Heart Attack Prevention Project Team
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Abstract

Background

Although guidelines recommend guideline-directed medical therapy (GDMT) for patients with acute coronary syndrome (ACS), implementation is limited in clinical practice.

Aim

To assess the level of GDMT in ACS patients after discharge who attended cardiac rehabilitation (CR) programs and association with clinical outcomes.

Method

A cross-sectional study was conducted in 13 rural and 10 metropolitan CR programs via all modes of delivery (face-to-face, telephone, or general practice-hybrid) operating in South Australia, Australia. ACS patients were included if they were ≥18 years of age and were referred and attended CR programs with medication details recorded in their hospital discharge summary. GDMT was assessed according to the Australian clinical guidelines for the management of acute coronary syndromes 2016. Prescription of all the four recommended medication classes was considered optimal. Logistic regression and χ2 test were used for association. Ethical approval was granted by the South Australian Department for Health and Wellbeing Human Research Ethics Committee (Reference No. HREC/15/SAH/63) and the Northern Territory Department of Health Human Research Ethics Committee (Reference No. HREC 2015-2484) which included a waiver of consent per the National Statement on Ethical Conduct in Human Research and the study conforms with the Good Clinical Practice Guidelines.

Results

Of the 1229 patients included, 74.6% were male and 41.1% had acute myocardial infarction. Only 39.7% of patients received optimal prescription. Prescription of any three or two medication class combinations occurred for 78.3% and 94.1% of patients, respectively. Optimal GDMT was associated with fewer hospital admissions (odds ratio = 0.647, 95% confidence interval 0.424–0.987, p = 0.043) with no significant gender association. Women were less likely to be prescribed angiotensin converting enzyme inhibitors (p = 0.003), angiotensin receptor blockers (p = 0.007), statins (p = 0.005), and any two (p < 0.001) and three combinations (p = 0.023) of medication classes.

Conclusion

GDMT prescription was suboptimal in patients with ACS before attendance at CR. Primary care and CR clinicians have missed an opportunity to implement best practice guideline recommendations, particularly for women.

Abstract Image

错失良机:对参加心脏康复项目的急性冠状动脉综合征出院患者的指导性医疗治疗和临床疗效进行临床数据关联研究
背景 尽管指南推荐急性冠状动脉综合征(ACS)患者接受指南指导下的药物治疗(GDMT),但在临床实践中的实施却很有限。 目的 评估参加心脏康复(CR)项目的急性冠状动脉综合征患者出院后的指导性药物治疗水平及其与临床结果的关系。 方法 在澳大利亚南澳大利亚州的 13 个乡村和 10 个大都市通过各种模式(面对面、电话或全科-混合模式)开展了一项横断面研究。年龄≥18 岁的 ACS 患者均被纳入研究范围,他们被转诊并参加了 CR 项目,出院摘要中记录了他们的用药详情。GDMT根据2016年澳大利亚急性冠状动脉综合征管理临床指南进行评估。所有四类推荐药物的处方均被视为最佳处方。采用逻辑回归和χ2检验进行关联分析。南澳大利亚州卫生与福利部人类研究伦理委员会(编号:HREC/15/SAH/63)和北领地卫生部人类研究伦理委员会(编号:HREC 2015-2484)对该研究进行了伦理审批,其中包括根据《国家人类研究伦理行为声明》放弃同意,且该研究符合《良好临床实践指南》。 结果 在纳入的1229名患者中,74.6%为男性,41.1%患有急性心肌梗死。只有 39.7% 的患者获得了最佳处方。分别有78.3%和94.1%的患者处方了三种或两种药物组合。最佳 GDMT 与较少的入院率相关(几率比 = 0.647,95% 置信区间为 0.424-0.987,p = 0.043),与性别无明显关系。女性获得血管紧张素转换酶抑制剂(p = 0.003)、血管紧张素受体阻滞剂(p = 0.007)、他汀类药物(p = 0.005)以及任意两种(p < 0.001)和三种药物组合(p = 0.023)处方的可能性较低。 结论 在接受 CR 治疗前,ACS 患者的 GDMT 处方并不理想。初级保健和 CR 临床医生错过了实施最佳实践指南建议的机会,尤其是对女性而言。
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来源期刊
Journal of Pharmacy Practice and Research
Journal of Pharmacy Practice and Research Health Professions-Pharmacy
CiteScore
1.60
自引率
9.50%
发文量
68
期刊介绍: The purpose of this document is to describe the structure, function and operations of the Journal of Pharmacy Practice and Research, the official journal of the Society of Hospital Pharmacists of Australia (SHPA). It is owned, published by and copyrighted to SHPA. However, the Journal is to some extent unique within SHPA in that it ‘…has complete editorial freedom in terms of content and is not under the direction of the Society or its Council in such matters…’. This statement, originally based on a Role Statement for the Editor-in-Chief 1993, is also based on the definition of ‘editorial independence’ from the World Association of Medical Editors and adopted by the International Committee of Medical Journal Editors.
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