Medication burden in patients with acute coronary syndromes
Eric A Wright1, Steven R Steinhubl, J B Jones
1Geisinger Health System, 190 Welles St, Ste 128, Forty Fort, PA 18704.
Insights
Medication complexity significantly increases for acute coronary syndrome (ACS) patients from hospital admission to discharge. This highlights the need for better management of cardioprotective medications during the peri-hospitalization period.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Cardioprotective medications are crucial for managing acute coronary syndromes (ACS).
- However, these medications contribute to overall medication complexity for patients.
- Understanding medication patterns is vital for optimizing patient care post-ACS.
Purpose of the Study:
- To describe cardioprotective medication use in ACS patients.
- To quantify changes in medication regimens from admission to discharge and post-discharge.
Main Methods:
- Retrospective cohort study utilizing electronic health records (EHR).
- Inclusion of 4767 patients aged 18-89 discharged with ACS (2008-2012).
- Comparison of medication use at admission, discharge, and within 90 days post-discharge.
Main Results:
- Total medication count increased from 8.6 to 11.4 per patient from admission to discharge.
- Proportion of patients taking medications ≥2 times daily rose from 64% to 90%.
- Significant increases in cardioprotective drug use: aspirin (+76%), statins (+72%), beta-blockers (+85%), ACE inhibitors/ARBs (+29%), and P2Y12 inhibitors (4-fold).
Conclusions:
- Patients with ACS experience high medication complexity, with substantial regimen changes during hospitalization.
- Findings underscore the need for strategies to manage medication burden in the ACS peri-hospitalization period.
- Informed clinical and policy decisions can improve medication management for ACS patients.
Objectives:
Cardioprotective medications improve outcomes following acute coronary syndromes (ACS) but add to medication complexity. We set out to describe the use of these medications and quantify medication changes in patients admitted and discharged for ACS.
Study Design:
Retrospective cohort study.
Methods:
Using archived data from the electronic health record (EHR), we evaluated patients with ACS admitted to 1 of 2 hospitals between January 2008 and December 2012. Patients aged 18 to 89 years who were discharged with a principal diagnosis of ACS were included in the study. Descriptive statistics were compiled and medication use was compared at 3 time points: admission, discharge, and within 90 days post discharge.
Results:
This study included 4767 patients. The mean number of total medications increased from 8.6 ± 6.5 to 11.4 ± 5.4 from admission to discharge, dropping slightly within 90 days post discharge (11.1 ± 5.2). Patients taking medications at least twice daily increased from 6.4 of 10 at admission to 9 of 10 at discharge. Cardioprotective medication use increased by a relative 76% for aspirin, 72% for statins, 85% for beta-blockers, and 29% for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers from admission to discharge, whereas P2Y12 receptor inhibitor use increased 4-fold.
Conclusions:
Medication complexity among patients with ACS are high, with notable changes from admission to discharge. Awareness of the extent of medication burden provides clinicians and policy makers with insight to help address medication use during the ACS peri-hospitalization period.
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