Trends in prescribing optimal medical therapy at discharge following percutaneous coronary intervention in a tertiary care hospital in the UAE.

Abstract

Background: Optimal medical therapy (OMT) is recommended in patients with coronary artery disease (CAD) following percutaneous coronary intervention (PCI) to enhance the clinical outcomes and support secondary prevention. However, real-world data on OMT prescription practices in the United Arab Emirates (UAE) remain limited. This study aimed to evaluate the prevalence and determinants of OMT prescription at hospital discharge in a UAE tertiary care setting.

Methods: This retrospective observational study included 103 consecutive patients who underwent PCI between January 2021 and June 2023 at a tertiary academic hospital in the UAE. Demographic and clinical data, including comorbidities and discharge medications, were collected from electronic medical records. OMT was defined as the concurrent prescription of aspirin, a P2Y12 inhibitor, statin, β-blocker, and either an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). Patients were stratified into OMT and non-OMT groups. Categorical variables were compared using the chi-square test or Fisher's exact test, as appropriate, while non-normally distributed continuous variables were analyzed using the Mann-Whitney U-test. Multivariate logistic regression was used to identify factors independently associated with OMT prescription at discharge.

Results: Among the 103 patients, the median age was 49.0 years [interquartile range (IQR): 44.3-54.1], with a predominance of males (93.2%) and non-Arabs (74.8%). OMT was prescribed at discharge in 39 patients (37.9%). Multivariate analysis revealed that diabetes (adjusted odds ratio [aOR] = 3.86, 95% confidence interval [CI]: 1.42-10.52, p = 0.01), and hypertension (aOR = 5.99, 95% CI: 2.04-17.60, p = 0.001) were significantly associated with higher odds of OMT prescription. In contrast, age >50 years (aOR = 0.23, 95% CI: 0.08-0.65, p = 0.01) and the presence of acute heart failure (aOR = 0.06, 95% CI: 0.01-0.60, p = 0.02) were associated with lower odds.

Conclusion: The rate of OMT prescriptions at discharge was comparable to international studies, though suboptimal. Diabetes and hypertension were positive predictors, while advanced age, and acute heart failure were negative predictors of OMT prescription. Multicenter studies with larger sample size would be needed to get more details. These findings suggest a need for targeted interventions to improve adherence to guideline-directed therapy. Future multicenter studies with larger sample sizes are warranted to validate these observations.