Physicians' adherence to acute coronary syndrome prescribing guidelines in Vietnamese hospital practice: a
Thang Nguyen1,2, Thao H Nguyen2,3, Hoa T K Pham4
1Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam.
Insights
Physicians in Vietnam largely followed acute coronary syndrome (ACS) prescribing guidelines, with high rates for aspirin and dual antiplatelet therapy. However, beta blocker and clopidogrel loading dose prescriptions were suboptimal.
Area of Science:
- Cardiology
- Clinical Pharmacy
- Health Services Research
Background:
- Acute coronary syndrome (ACS) management relies on evidence-based guidelines.
- Assessing adherence to these guidelines is crucial for optimizing patient outcomes.
- Understanding prescribing patterns in different healthcare settings, like Vietnam, is important for global health initiatives.
Purpose of the Study:
- To evaluate the adherence of physicians to established prescribing guidelines for patients with acute coronary syndrome (ACS).
- To identify potential areas for improvement in ACS pharmacotherapy within Vietnamese hospitals.
Main Methods:
- A retrospective cross-sectional study was conducted, reviewing medical records of ACS patients from two public hospitals in Ho Chi Minh City, Vietnam (January-December 2013).
- The study determined the percentage of eligible patients receiving guideline-recommended medications.
- Multivariate logistic regression analysis was employed to identify factors associated with non-adherence.
Main Results:
- A total of 284 patients met the inclusion criteria. High adherence was observed for aspirin (97.9%), dual antiplatelet therapy (92.3%), ACEI/ARB (89.1%), and statins (94.1%).
- Prescribing of beta blockers (58.7% at arrival) and clopidogrel loading doses (55.8%) was suboptimal.
- Patients undergoing invasive procedures showed higher likelihoods of receiving guideline-recommended medications at discharge.
Conclusions:
- Physician adherence to ACS prescribing guidelines in Vietnamese hospitals is generally high.
- Opportunities exist to improve the utilization of beta blockers and clopidogrel loading doses.
- Further investigation is needed to understand why a significant number of patients did not complete their prescribed treatment.
Objectives:
To determine the extent of physicians' adherence to prescribing guidelines for acute coronary syndrome in Vietnamese hospitals.
Methods:
Retrospective cross-sectional study of medical records of all patients with ACS admitted to two public hospitals in Ho Chi Minh City, Vietnam, from January to December 2013. Percentages of eligible patients receiving guideline-recommended medications were determined. Factors associated with non-adherence were identified using multivariate logistic regression.
Results:
Overall, 711 medical records were reviewed and 284 patients fulfilled inclusion criteria (mean age 64 years; 69.4% male). Of those patients eligible for treatment, aspirin was prescribed for 97.9% at arrival and 96.3% at discharge; dual antiplatelet therapy was prescribed for 92.3% at arrival and 91.7% at discharge; loading doses were prescribed for 79.5% (aspirin) and 55.8% (clopidogrel); beta blockers were prescribed for 58.7% at arrival and 76.7% at discharge; angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) were prescribed for 89.1% at arrival or discharge; and statins were prescribed for 94.1% at arrival and 90.7% at discharge. Patients undergoing an invasive procedure were more likely to receive guideline-recommended medications at discharge: dual antiplatelet therapy (OR 3.77; 95% CI 1.23-11.52), beta blocker (OR 3.95; 95% CI 1.86-8.40) and ACEI/ARB (OR 4.01; 95% CI 1.30-12.41). Ninety of the excluded patients were discharged without completing treatment.
Conclusions:
In general, physicians closely adhered to ACS prescribing guidelines in Vietnamese hospital practice. Prescribing of beta blockers and clopidogrel loading doses was probably suboptimal. Why patients do not complete treatment needs to be investigated.
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