Interhospital Variability in Drug Prescription After Acute Coronary Syndrome: Insights From the ACDC Study
Ignacio Ferreira-González1, Xavier Carrillo2, Victoria Martín3
1Unidad de Epidemiología, Servicio de Cardiología, Hospital Universitari Vall d'Hebron, CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
Insights
Prescription of aspirin, statins, and ACE inhibitors post-acute coronary syndrome is suboptimal and varies significantly between hospitals. This variability may reflect differing healthcare approaches rather than patient outcomes.
Area of Science:
- Cardiology
- Clinical Pharmacy
- Health Services Research
Background:
- Acute coronary syndrome (ACS) management guidelines recommend specific drug combinations for optimal patient outcomes.
- Acetylsalicylic acid, statins, and angiotensin-converting enzyme inhibitors (ACEIs) are cornerstone therapies post-ACS.
Purpose of the Study:
- To assess the discharge prescription rates of acetylsalicylic acid, statins, and ACE inhibitors in ACS patients.
- To investigate interhospital variability in the prescription of these three key medications.
- To explore the prognostic impact of this combined prescription on patient outcomes.
Main Methods:
- Utilized hierarchical analysis including intraclass correlation coefficient and median odds ratio to quantify interhospital variability.
- Employed Cox regression analysis to evaluate the 2-year risk of death or myocardial infarction associated with the triple therapy prescription.
Main Results:
- Only 53.3% of 917 ACS patients received all three agents (aspirin, statins, ACEIs) at discharge.
- Significant interhospital variability in prescription rates was observed, ranging from 23% to 77%.
- No significant association was found between the prescription of all three drugs and the risk of adverse events at 2-year follow-up.
Conclusions:
- The prescription rate of acetylsalicylic acid, statins, and ACE inhibitors following ACS is suboptimal.
- Substantial variability exists among healthcare centers in prescribing these essential medications.
- This variability may stem from differing institutional healthcare strategies or approaches.
Introduction And Objectives:
To analyze the rate of patients admitted for acute coronary syndrome who concomitantly received acetylsalicylic acid, statins, and angiotensin-converting enzyme inhibitors at discharge, and to analyze interhospital variability in the prescription of these drugs and its potential prognostic impact.
Methods:
Interhospital variability in drug prescription was estimated using the intraclass correlation coefficient and median odds ratio (hierarchical analysis). Cox regression analysis was used to estimate the risk of death or myocardial infarction associated with prescription of all 3 agents at 2-years of follow-up.
Results:
In total, 489 (53.3%) of 917 patients were prescribed all 3 agents. The rate was similar in patients with hypertension and diabetes (56.8%). There was significant variability among centers in the prescription of the 3 drugs at discharge (from 23% to 77% of patients). Hypertension (odds ratio=1.93; 95% confidence interval, 1.42-2.61), ejection fraction < 45% (odds ratio=2.2; 95% confidence interval, 1.44-3.37), being in a clinical trial (odds ratio=1.89; 95% confidence interval, 1.24-2.88), and renal failure (odds ratio=0.53; 95% confidence interval, 0.29-0.94) were associated with prescription of the 3 drugs. After adjustment for these factors, residual variability persisted (intraclass correlation coefficient 0.046 [95% credibility interval, 0.007 to 0.192]; median odds ratio=1.46 [95% credibility interval, 1.16-2.32]). There was no clear association between the prescription of all 3 drugs and the risk of events during follow-up (hazard ratio=0.81, 95% confidence interval, 0.55-1.18; P=.27).
Conclusions:
The prescription rate for acetylsalicylic acid, angiotensin-converting enzyme inhibitors, and statins after acute coronary syndrome is suboptimal, varies among centers, and is possibly related to different health care approaches.
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