[Medication after hospitalization for acute coronary syndrome: Determinants of individual drug changes]

This study examines drug changes from therapeutic medication given during hospitalization to that in further out-of-hospital treatment prescribed by medical practitioners of patients with acute coronary syndrome. The main focus of this trial was to demonstrate any change in such medication after hospital discharge.

During a six-month period a "health diary" covering health status and medication was filled in weekly by 104 patients who had been hospitalized for acute coronary syndrome in the Cologne area of Germany. The mean age of the patients was 62 years and 76 (73%) of them were men. Changes in medication between hospital discharge and further treatment were recorded. Prescribed daily doses and guideline-recommended daily doses were compared for each drug class.

Changes in medication were not observed in a population-based approach but occurred on an individual patient's level in 40% of them when only those drugs recommended in therapeutic guidelines were analysed. A fifth more lipid-lowering drugs and over a third more beta-blockers had been prescribed than recommended in the appropriate guidelines. For other groups of drugs no significant deviations from guideline recommendations were noted.

No obvious interface problem between hospital and further-treatment medication was observed in a population-based approach. However, variations in medication were found when drug prescriptions of individual patients were compared But despite these variations in individual patient the overall prescribing practice by physicians out of hospital showed good implementation of the therapeutic guidelines.