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
{"title":"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","authors":"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","doi":"10.1002/jppr.1923","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Although guidelines recommend guideline-directed medical therapy (GDMT) for patients with acute coronary syndrome (ACS), implementation is limited in clinical practice.</p>\n </section>\n \n <section>\n \n <h3> Aim</h3>\n \n <p>To assess the level of GDMT in ACS patients after discharge who attended cardiac rehabilitation (CR) programs and association with clinical outcomes.</p>\n </section>\n \n <section>\n \n <h3> Method</h3>\n \n <p>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 <i>χ</i><sup>2</sup> 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 <i>National Statement on Ethical Conduct in Human Research</i> and the study conforms with the <i>Good Clinical Practice Guidelines</i>.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 4","pages":"314-322"},"PeriodicalIF":1.0000,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1923","citationCount":"0","resultStr":"{\"title\":\"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\",\"authors\":\"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\",\"doi\":\"10.1002/jppr.1923\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Although guidelines recommend guideline-directed medical therapy (GDMT) for patients with acute coronary syndrome (ACS), implementation is limited in clinical practice.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Aim</h3>\\n \\n <p>To assess the level of GDMT in ACS patients after discharge who attended cardiac rehabilitation (CR) programs and association with clinical outcomes.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Method</h3>\\n \\n <p>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 <i>χ</i><sup>2</sup> 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 <i>National Statement on Ethical Conduct in Human Research</i> and the study conforms with the <i>Good Clinical Practice Guidelines</i>.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>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.</p>\\n </section>\\n </div>\",\"PeriodicalId\":16795,\"journal\":{\"name\":\"Journal of Pharmacy Practice and Research\",\"volume\":\"54 4\",\"pages\":\"314-322\"},\"PeriodicalIF\":1.0000,\"publicationDate\":\"2024-06-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1923\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Pharmacy Practice and Research\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/jppr.1923\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pharmacy Practice and Research","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jppr.1923","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
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
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.
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.