[Acute coronary syndrome: real-world data from the Lombardy Region]
Raffaella Ronco1, Giovanni Corrao1
1Centro di Ricerca Interuniversitario Healthcare Research & Pharmacoepidemiology, Università di Milano-Bicocca, Milano.
Insights
Adherence to post-discharge treatment pathways significantly reduces long-term cardiovascular event risk in acute coronary syndrome (ACS) survivors. Early rehabilitation and prescribed medications are key to preventing future hospitalizations.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Health Services Research
Background:
- Short-term outcomes of acute coronary syndrome (ACS) are well-documented.
- The long-term impact of post-discharge monitoring, treatment, and rehabilitation on ACS outcomes remains under investigation.
- Understanding adherence to therapeutic pathways is crucial for preventing long-term cardiovascular events.
Purpose of the Study:
- To evaluate adherence to a defined therapeutic pathway for ACS survivors.
- To assess the impact of this adherence on the long-term risk of cardiovascular (CV) hospitalization.
Main Methods:
- Analysis of administrative databases for 106,104 ACS patients (aged 40-90) discharged between 2009-2015.
- Longitudinal follow-up from discharge to CV hospitalization or censorship (death/emigration) by June 30, 2018.
- Cox proportional hazards models used to assess the association between drug therapy/rehabilitation and CV hospitalization risk.
Main Results:
- Prescription of beta-blockers, statins, antiplatelet agents, and ACE inhibitors/ARBs post-discharge reduced CV hospitalization risk by 13%, 10%, 5%, and 3%, respectively.
- Rehabilitation within two months of discharge demonstrated a significant 29% risk reduction.
- Confidence intervals indicate statistically significant risk reductions for all analyzed interventions.
Conclusions:
- Close monitoring and strict adherence to recommended post-ACS treatment pathways are associated with reduced long-term CV event risk.
- Early initiation of rehabilitation and consistent medication use are vital components of effective ACS long-term management.
- These findings support the implementation of structured post-discharge care protocols to improve patient outcomes.
Background:
The short-term outcomes of acute coronary syndrome (ACS) have been extensively studied; however, the role of post-discharge monitoring, treatment and rehabilitation in the prevention of long-term outcomes remains debated. The aim of this study was to measure the adherence to a therapeutic pathway and to assess its impact on the log-term risk of hospitalization for cardiovascular (CV) causes.
Methods:
A total of 106 104 incident cases of ACS, in which patients aged 40-90 survived hospitalization, were recorded in the administrative databases between 2009-2015 and were identified as index shelters. Each patient had accumulated person-years from the index hospitalization discharge to the first of the following events: hospitalization for CV events or censorship (death, emigration, June 30, 2018). The association between exposure (drug therapy and rehabilitation) and risk of CV hospitalization was assessed using a Cox model in accordance to the intention-to-treat principle.
Results:
Compared to untreated patients, those who received prescriptions of beta-blockers, statins, antiplatelet agents or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers in the year after the index discharge experienced a risk reduction of 13% (95% confidence interval [CI] 11-15%), 10% (95% CI 8-12%), 5% (95% CI 2-6%), and 3% (95% CI 1-6%), respectively, whereas rehabilitation within 2 months reduced the risk by 29% (95% CI 26-32%).
Conclusions:
Patients undergoing close monitoring with strict adherence to the recommended treatment after admission have a reduced risk of experiencing long-term CV events.
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